Hampi

During my first week of rotations at St. John’s, I met a group of American and American/Israeli medical students that are at St. John’s for 6 weeks of an elective course. The 5 of them are all doing the same rotations but two are from Columbia in New York and the other 3 are Americans that are going to medical school in Israel that associated with Columbia. Since most of the Germans were going away for a long weekend, I decided to join 4 of the Americans in a weekend trip to Hampi. I definitely felt the need to get out of town after moving into the Annex 1 (see previous blog). Hampi was once the site of a large Hindu empire in India. It is thought of as the home of the monkey Gods. It is a city of ruins from the temples and height of the Hindu empire that once ruled in the area. It is also a nice break from the big city life of Bangalore as the city of Hampi lies along a river and the scenery is a mix of rice paddies and giant boulder hills. 

The American students arranged the transportation and the lodging which was very nice for me since I was able to just join in without having to do much of the planning. After traveling for a while on my own, this is a welcome break. We were picked up from the Annex 3 at 12am Friday night/Saturday morning by a hired driver. We rode semi-comfortably in a Toyota SUV for 7+ hours to Hampi. Unfortunately for me, I ended up in the front co-pilot seat which meant that at every toll stop (which seemed to occur about ever one hour), I was woken up by the driver to pay the toll. Of course this meant that by the time we arrived in Hampi, I was not feeling very rested. We made our way to our accommodation - Shanthi Guest House - dropped off our bags and cleaned up before heading out to start seeing the sights. We only had 1.5 days to see Hampi which from what I had heard from the Germans is not nearly enough time as the pace of Hampi is very relaxed and once you get there, you don’t really feel in a rush to leave.

On the recommendation of the German students, I suggested we rent bicycles to bike around the rice paddies and see some of the temples on the other side of the river from Hampi Bazaar and the same side where our guest house was. I was overruled by the other American students who really wanted to rent mopeds (even though they were much more expensive and didn’t include a helmet and to me felt much more dangerous to ride around on the rule-less streets of India). I closed my eyes, took a deep breath and sent out positive thoughts for my safety. I didn’t ride my own since I had never driven one before, I didn’t feel comfortable driving one myself. In retrospect, I’m not sure if that was the best idea although I did make it through the day in one piece and we only fell over one time - a very low speed fall to the side which helped us to learn early on that I needed to get off the bike when we were turning around. 

It was a beautiful day and was incredibly peaceful riding through the rice paddies and the boulder hills. I would have preferred being on a bike not only for my own safety, but also because bicycles seemed to fit the atmosphere of Hampi much more than a moped. I guess this is what happens when you travel with a group - I don’t have the same independence as when traveling alone and when people differ on what they want to do, someone ends up not getting to do the things they want. I still had a great time and really enjoyed Hampi, so I can’t complain although if I had to do it again, I would go about it differently.

We visited a few different Hindu temples recommended by the Lonely Planet although several of the temples have similar names and the maps are not all that great so we ended up going to one temple that we discovered later was not the recommended temple to visit - this was the first temple we visited which I did not find all that impressive. The best part of the first temple were the children that were wandering around the temple grounds. They were dressed up in very colorful clothes and were quite friendly and wanted to take pictures with us which is always a joy.

The second temple we visited was really cool not because of the temple itself (after a while, a lot of them start to look the same...) but because of the landscape it was situated on. After walking past the temple, there was a small canal/well that provided a great photo opportunity. When we walked a bit further, we ended up in these cave-like structures created by the piles of boulders. Inside was much cooler than standing outside in the sun and was a refreshing break. Continuing through the caves, we could climb up a sort of rock scramble stair case to the top of the boulder hill and had a great view overlooking the landscape of Hampi. From here, we could see the river, the rice paddy fields, and the monkey temple which was on a higher boulder hill and from where we planned to see the sunset.

We left this temple and had lunch at an Indian restaurant that served only one thing - the South Indian Thali. We each got a metal plate with a palm leaf on it and had several different gravies (curries), breads, and rice piled on. It was delicious. After lunch we made our way on the mopeds to a reservoir lake that one of the girls had heard about from a rickshaw driver she started talking to when we got into Hampi that morning. It took a while for us to find the reservoir but we did find it and a large group of people from all over Europe that were swimming and cliff jumping off the boulders into the lake. Hot, sweaty, and dusty from the night of traveling and the day riding around on the mopeds, getting in the lake sounded heavenly. Of the 5 of us, 4 of us joined in the cliff jumping and were rewarded with being submerged in cool water.

Refreshed after our brief swim, we took the mopeds to the monkey temple. To reach the top of the monkey temple requires a climb of about 570 stairs. It was a long way to the top but on the way, I had a gorgeous view of the surrounding countryside and was entertained by several monkeys playing on my walk up. It was nice to sit and relax at the top while waiting for the sun to set - relaxing until a snake crawled out from between two of the boulders and slithered right in front of my feet. In my state of fear, I somehow remembered that with a snake, you should stay very still which I somehow managed to do and the snake slid away. Thankfully the sun set soon afterwards and we made our way back down the 570 stairs to the mopeds and back to our hotel. 

Our hotel was a collection of individual huts that to my great satisfaction had 24hrs hot water. I took a much desired hot shower and after we all felt clean again, we had dinner at the hotel restaurant. Exhausted after our day, we all went to sleep early.

Hanuman (monkey) Temple

Sunday morning we got up fairly early to check out, drop our bags off with our driver, and see the sites on the other side of the river before heading back to Bangalore. We took the ferry across the river and dropped off our bags. We then hired a couple of rickshaw drivers for a half-day tour of Hampi. We started out at the Royal Centre of the city where the ruins of the Hindu royalty as well as a giant elephant stable were located. After visiting the Royal Centre, we made our way to the Queen’s bathtub which is more like a swimming pool in size. I can imagine that if I were the queen, I would not leave my bathtub. Our final tour stop was at the Vittala Temple which is the main highlight of the Hampi tour. It is a very well preserved Hindu temple that reminded me a lot of the new 2005 temple built in Delhi. I liked this one better just because it was older. It was just as exquisite with the entire temple carved with spectacular Hindu figures. There was also a large stone chariot in the center of the temple that at one time actually carted people around.

view from Hanuman Temple

Satisfied with our tour, we went to the Mango Tree Cafe for lunch. It was a fantastic cafe with an incredible view and even better food. We enjoyed our meals slowly before boarding the SUV for the ride back to Bangalore. I again sat in the front seat on the way back but thankfully we arrived in Bangalore in time for me to get an adequate (well, as good as it can be in the Annex 1) night’s sleep before starting my second week of orthopedics. Namaste.

AM Ferry Crossing

elephant stable

queen's bathtub

Vittala Temple

Vittala Temple

"This is not kindergarten."

Banana Beach Bar

I have to say that although things move quite slowly here in India, the time is going by rather quickly. I have already been in Bangalore for nearly 2 weeks at this point and have done a terrible job keeping up with my blogging. I spend the day in the hospital on my elective rotations then go back to my room and usually eat something and do some of my laundry via handwashing. I discovered that handwashing clothes takes a long time (maybe it’s because I am never quite sure how to tell when they are clean...) and the best way to approach laundry here is to do a little each day and hang it out on the line to dry. Since we do not have a kitchen in our housing accommodation, I go out to eat a lot. It’s pretty cheap to eat out depending on where you go, but I usually spend about $2 or less per meal. The main problem I have with going out to eat deals with my first statement - things move quite slowly here in India, including the food service. It is not unusual for a meal out to take a full 2 hours starting from the time we start walking there to the time we get back to the Annex. I do have some snacks in my room for when I just really don’t feel like going out. Walking around is always an experience as there don’t seem to be any traffic rules and as a pedestrian, I really feel that I have no right-of-way even if the traffic signals say I do. The sidewalks are in pretty lousy condition as well. As a result of all this, by the time I get back from dinner, it is time to shower and get ready for bed. 

Life in Bangalore:

There are a lot of places to eat around Bangalore. The city is home to about 8 million people and as a result is rather large and crowded. There are several good restaurants within walking distance from the hospital and these are the places I typically eat. Sukh Sagar is a favorite of mine and of the German medical students that I have gotten to know since arriving in Bangalore. Monday night, two of the German students wanted to go eat at a place called Food Street. I don’t know if that is the actual name of the street, but it is a place known for it’s street food. Vendors come out in the evening with a wide range of Indian cuisine made fresh before you for you to enjoy. It’s a great place to go with friends because we are able to sample several different things. This was definitely my favorite food experience in India so far.

mango corn at Food Street

I have been very thankful for my new German friends and have benefitted greatly from their knowledge of Bangalore since most of them have been here since the beginning of December. They always have places to try and are so inclusive. The downside to that is that I wind up spending a lot of my evenings out and don’t get back very early to get some reading or blogging done before I have to get ready for bed. The upside (and the upside definitely wins) is that I am making some great friends and getting to experience more of Bangalore than I think I would have on my own. Some of the other places I have enjoyed going out to with them include the Banana Beach Club (a really cool bar with a beach theme and some of the tables are actually little islands that you have to step across water in order to sit at them), The Egg Factory (known for it’s European/American menu - sometimes you just really need a taste of home), and the Chocolate Room (yes, a restaurant devoted to all things chocolate). 

Another great thing besides the friendship and the food experiences that I have had with my German friends is that they included me in their plans when we were kicked out of the Annex 3 on January 27 due to the arrival of a lot of Catholic bishops who were very clearly more important then the foreign elective medical students. The alternative accommodation offered to us was truly unacceptable - a hospital about 20km away (which would probably take 1 hr by car or 2 hrs by bus each way just because of the traffic) that really didn’t have much surrounding it. We would have seriously been stuck. The Germans were instead able to arrange for us to stay at the Annex 1 which is another lodging on the St. John’s hospital grounds. We have to share rooms, but at least we don’t have to commute 2-4 hrs per day to get to the hospital. 

general hospital ward room

The Annex 1. There really is not much good to say about the place. It’s on the hospital campus and right across from the hospital canteen. My internet works better here than at the Annex 3. And that’s about all it has going for it. My room is equipped with an Indian toilet: a porcelain-lined hole in the floor that you have to squat over. For those of us not used to toilets like this, it is uncomfortable and difficult to use. For me with my broken hip and limited hip abduction and flexion abilities, it is a real challenge. All I can say is that I don’t think I have ever spent so much time washing my feet :( Continuing with the bathroom - there is no shower and no hot water. I fill a bucket with cold (not freezing, but cold) water and take a bucket shower every morning. At least it wakes me up I guess. Now those things are uncomfortable, but manageable. Even the rock hard mattress would be tolerable in addition to the bathroom issues. Even the fact that the walls are paper thin and I hear everything out in the hallway which for some reason seems to be a popular hang out around 5 in the morning could be tolerable. The thing that really puts the Annex 1 as the worst place I have ever lived in my entire life is the cockroaches. Disgusting, scurrying cockroaches. Also, the room just does not seem to be all that clean. I am counting down the days until I can leave. I fully plan to harass the Annex 3 as soon as the bishops leave on February 10 to get my room back in place that is at least clean and has the bonus of a hot shower, a relatively soft bed, and a normal toilet. Thank goodness I have plans to be gone for a few weekends of the Annex 1 experience which cuts down on the time I actually have to spend here. 

The Hospital:

As I mentioned in my previous blog, I am spending the first two weeks of my elective time at St. John’s in the orthopedics department. Medical students in India are apparently not allowed to touch patients so my experience as a student is limited mainly to observation. This was also my experience for the most part in Sweden as well. The nice thing about observing in India is that there is a lot to see. Everyday I encounter patients and cases that are things unique to the tropics and to the developing world. It is a fascinating learning experience. I also look at it this way - India is preparing me with theoretical learning about medicine in the tropics and in the developing world so that when I arrive in Kampala, Uganda in April, I will be ready to apply this knowledge in practice since I believe my experience will be much more hands-on there.

The orthopedics department is a very busy place. Our morning rounding list in the hospital is between 35 and 40 patients. In clinic, we see 40+ patients in a half-day. Even though an orthopedic surgery residency in India is a short 3 years, those 3 years are packed with experience. Residents (at least interns) only get 1 day off per month. In the morning, the resident/intern will present the patients that were admitted to the service the night before. Even if they had spent the night on call, they are expected to know everything about the patient, the patient’s problem, and the theoretical knowledge behind the approach to that problem. I have never seen such intense pimping in my life. When the resident/intern didn’t know the answer, the staff would tell him to write down the questions and read up on it later to find the answer. At one point after several questions to which the intern did not know the answer, one of the staff started to tell him the answer. He was stopped by a more senior staff member who said, “This is not kindergarten. He needs to learn it for himself.” Yikes! 

OR scrub sink

It’s always interesting to see how a hospital is run in another country. I can’t generalize and say that how it is at St. John’s is representative of all of India, but it at least gives me an idea of the hospital system in place here. I’m not sure if this is because it is a Catholic hospital, but the nurses are all referred to as “Sister.” I don’t think I have once heard a doctor use a nurse’s actual name - they are all just “sister.” I also haven’t seen any male nurses, but the male staff in the OR are sometimes referred to by “brother” and sometimes referred to by name. In this system, you do not need to have a referral to see a specialist. Any patient can see any type of doctor they want and at least at St. John’s, most of them don’t have appointments beforehand. The hospital has limited resources. I don’t think this is the case for all hospitals but St. John’s serves a poorer population because it is a Catholic mission hospital. For the prevention of pressure ulcers, they use gloves filled with water and place them under the patient’s heels. The beds in the general wards are not adjustable hospital beds, so in order to elevate the foot or the head of the bed, concrete blocks are placed underneath the bed legs. It works. I have seen a lot of family members staying with patients and if they are not rich enough to afford a private room that has a bed for family, the family member will lay a mat on the floor beneath the patient’s bed and sleep on that. In the OR, they use a lot of reusable items. The scrub gowns are cloth as are the drapes and I noticed that some of them have holes. There seem to be a lot of people that wander in and out of the OR - mostly OR staff. They tend to sit in a room off to the side of the OR and chit-chat while the surgery is going on. It kind of reminded me of Haiti when the interpreters would all congregate in a clinic room and socialize even if a patient was in the room. This sometimes meant that they weren’t doing their job which is also the case here at times.

hospital bed with the foot elevated

I have seen a lot of interesting cases during my time on the orthopedic service so far. There is a lot of trauma at the hospital which is similar to the trauma seen at home. Tuberculosis is very prevalent here and there are a lot of patient’s with TB infecting nearly any part of the body. Thankfully, only the pulmonary TB is ultra contagious and I have yet to see a case of that. I have seen patient’s with TB of the spine, abdomen, hip, and lymph nodes. I have seen a couple of patients who suffered fat embolisms after long bone fractures because they were not treated promptly after their injury. In peds clinic, I saw two children with radial club hand - a congenital deformity which has increased incidence in consanguineous marriages resulting in the absence of the radius. The forearm tends to be short because the ulna bows and the hand is deviated towards the pinky. The thumb is also hypoplastic and basically non-functional. The surgical correction sounds pretty cool - the first procedure is an ulnar centralization where the ulna is moved to the center of the forearm to help straighten out the arm. Then in a second procedure, the index finger is rotated so that it can function as a thumb so the child will be able to grasp objects and write. Although the hospital is able to help kids like this, there are an unfortunate number of patients with orthopedic problems that do not get to a hospital early on and a result have a huge morbidity from their injuries. There are a lot of neglected cases that end up with the patient having some permanent disability because they were not able to receive proper care early on. Although I wish I could participate more in the care of patients, I have been really interested in the things I have seen and have been really motivated for independent study. I think this will be a valuable learning experience medically and personally and after my first week, despite some of the challenges, I am glad to be spending time in this incredible place. Namaste.

1st Official Day - Orthopedics at St. John's Medical College

This week I started my elective training at St. John’s Medical College in Bangalore, India. I have decided to start with two weeks of orthopaedics. The morning started out with breakfast at the hospital canteen with Julia and Sandhya. For 30 rupees (about $0.60) I had tea and toast for breakfast. (I ate a banana before heading to breakfast for some fruit). The other German students joined us at the canteen and we walked to the Annex I where we are hoping to relocate during the two weeks we are kicked out of the Annex III due to the Bishop’s conference. As expected, it took way longer than it should have and was this complicated process to view the rooms then arrange for our two week stay. It seems like everything is set for us though and Friday I will be moving to the Annex I. It’s not as nice as the Annex III and we will most likely be sharing rooms and I am not sure if there is hot water. But at least we are on the hospital campus. And it’s only for two weeks. If it’s really miserable, I’ll be sure to take a weekend trip between the two weeks for a break!

clinic exam bed

I was worried that I would be late for my rotation. I got the orthopaedics office shortly after 9:30 and was told to go to the outpatient department (OPD) to meet with the head of the department and observe him for the day. When I arrived at the OPD, there were tons of waiting patients but no doctor. I asked if this was the place and was told to wait - he would arrive shortly. About an hour later, the ortho surgeon I was to observe arrived as well as one of the senior residents (ortho residency here is only 3 years after 5.5 years of medical school which is started immediately following high school). Clinic was completely crazy. Both the staff and the resident were seeing patients in the same room and I sat in a chair between them so I could observe both and get a sense of every patient. The two doctors were sharing a desk and there was no divider between the patients that each one was seeing. Privacy seems to not really exist here. Things were moving at a quick pace and I asked questions when I could get them in but mostly I just took it all in. We stopped for a coffee break about an hour and a half into the clinic. I finally got a chance to talk some with the staff doctor and tell him a little about myself and what I was hoping to get out of my time on the rotation. I said that I was hoping to get a sense of medical practice in India and see a wider range of pathology than I am exposed to in the US. I also said that I was hoping to improve my clinical skills. Both the staff and the resident were really helpful in showing me different exam techniques they used when evaluating orthopaedic patients. The clinic ended about 1:45 after seeing 41 patients. It really reminded me of the craziness of doing ortho clinic in Haiti...

Very few patients have an appointment – only 4 of the 41 patients seen today were scheduled. The rest of the patients walk in in the morning and are given a number in the queue then wait until their turn to be seen. The patients bring their own records to the clinic. 

clinic room

I was not disappointed in what I observed in clinic. There was the usual bread and butter ortho - back pain and arthritis - but also the unusual stuff that comes in the tropics and an unfortunate number of neglected cases that were not treated properly at the start due to lack of access and poverty. Tuberculosis is a big problem in India and is in the forefront of the differential for many clinical presentations. We had one patient today with TB of the spine. The other really interesting patient today was a boy who had been bitten by a snake and wound up with necrotizing fasciitis. He then had a mid-tarsal amputation of his foot to get rid of the infection. Now he has developed an equinous deformity due to unopposed plantar flexion from the achilles and is getting a pressure ulcer at the stump site. The staff surgeon is planning on correcting his deformity by removing one of the bones in his feet to bring the calcaneus and the calcaneus heel pad forward so that the weight of his body concentrates on that heel pad.

Speaking of interesting patients, I forgot to mention one other patient I met last Friday at the outreach clinic. It was a patient with Wilson’s disease which I have not seen before in the US. He had the classic Kayser-Fleischer rings in his eyes and a dystonia due to the copper deposits in his cerebellum. Great clinical findings to be able to make a diagnosis and treat him!

At the end of clinic, the staff invited me to the resident’s seminar at 2:30. Residents are responsible for giving lectures and are horribly pimped during their presentations in a very harsh way. The presentations are picked apart by the head of the department. I felt so sorry for the presenting resident. He seemed so nervous before the presentation started and was stopped on most every slide and asked a range of questions that he was expected to know the answers to, even the really obscure questions. At the end of the presentation, the head of the department told him what he should have also included and how he should approach his next presentation. His final conclusion - “It could have been better.” OUCH!

I came back to my room after the lecture and did some more handwashing of my clothes. I plan on reading up on TB tonight and am looking forward to a new day at the hospital tomorrow. Namaste.

It's All Part of the Experience...

First off, it is a complete nightmare to try and get connected in India. I have never had to jump through so many hoops or be so persistent to get something done in my life. Things here seem to run on phones so having an Indian phone number was a must especially since I am going to be here for a couple of months. Also, in order to get internet (which is most easily done with a 3G USB stick), you have to have a verifiable Indian phone number. Even to use WiFi in a cafe/coffee shop (which there aren’t many that have WiFi available), you have to have a verifiable Indian phone number. To have an Indian phone number, you have to buy a SIM card. In order to get a SIM card, you must have a passport size photo, a copy of your passport and visa, and a proof of address. On Friday morning, I met with the foreign student coordinator to fill out some paperwork, discuss my postings at the hospital, and to get a proof of address letter. My frustrations started early in the day on Friday. First of all, I sent in a payment to the school to do elective training here. When I arrived, Patima informed me that I still owed money to the school. Apparently because I sent in a cashier’s check in USD, some conversion fee was extracted to change it to rupees. So my $620 check to the school was only worth about $520 and I had to pay another $100. Of course no one tells you these things in advance. I feel like money is leeching out from me on a regular basis which just adds to the constant feeling of being drained that I have had since I arrived in India. After I paid my fee and gave her a passport size photo to put on my ID badge, I was brought to Dr. Sanjiv who is the physician in charge of the international students. He was in the middle of clinic but it didn’t seem to matter to be interrupting his patients for me to talk with him. Privacy doesn’t seem to really exist here in India. As we were discussing my electives, patients were brought into the clinic room to sit and wait until we were done with the discussion. The nice thing about electives at St. John’s is that they are very flexible. I can do pretty much whatever I want for however long I want. If I start a posting and don’t like it, I can switch after a week to something new. I told him that I was interested in doing emergency medicine, orthopaedics, ob/gyn, community health, and pediatrics. As soon as I mentioned orthopaedics, Dr. Sanjiv got all excited and asked what I was doing the rest of the day. Apparently there was a specialist outreach clinic that was traveling to a nearby village to provide a peds ortho clinic. He called the pediatrician on the team and got me a spot in the van to head to the village. 

Julia and me

It was a really great experience to spend part of the day at this village hospital. I saw several things that day in clinic that I have never seen before in my few years of clinical experience and things that I am not likely to see in the US. The first patient of the day was a child with (very obvious) rickets. Vitamin deficiencies are a major problem especially for poor people in India. I then met a child with dystonic type cerebral palsy that has affected his arms more than his legs. The child had taught himself to use his feet as hands and showed me how he could unwrap and eat candy and write with his feet. I then saw an adult with an amputated arm. This guy had been in a farm accident a few years ago and broke his arm. He didn’t have access to a hospital or medical facility so the local “medical” expert had him wrap his arm very tightly in bandages. This led to ischemia of his arm which then necrosed and became gangrenous. As a result, the patient had to have his arm amputated. A simple fracture that because of a lack of access resulted in the patient losing his dominant arm. I saw a child with isolated growth hormone deficiency - 12 years old and less than 3 feet tall. I saw an 11 month old baby with vitamin B12 deficiency (mother was breastfeeding but was B12 deficient due to being a lifelong vegetarian). And finally I saw a woman in her mid-30s with a post-polio residual palsy. Mid-30s and had polio. It was a great day for learning and seeing some really interesting medicine and on the drive back to St. John’s, the frustrations seemed to take a backseat to my excitement for this incredible learning opportunity.

Sandhya and me

After arriving back at the hospital, I went to Patima’s office to finish up my paperwork. She gave me my name badge and my posting letter for ortho to start on Monday. My proof of address letter still needed to be signed so she asked me to stop by Saturday morning to pick it up. I walked back to the Annex III and ran into a couple of the German students that I had met the night before. They were going out shopping and then to have dinner with the rest of the German students and a Nigerian student that was leaving on Saturday. They invited me to join them. I spent the rest of the afternoon with my new friends Julia and Sandhya who showed me around the neighborhood, where I needed to go to get a phone and internet, and had a blast! We ate dinner at a restaurant nearby the hospital and I met the other students. It was a great evening that ended with making plans for Saturday: lunch, more shopping, and an evening out at one of the clubs in Bangalore.

my room in the Annex

Saturday morning I went to Patima’s office to get my letter. When I walked in, she told me that it wasn’t ready and that I could pick it up on Monday. I told her that it takes a few days to get a working phone once you submit your application for the SIM card and I really couldn’t wait until Monday to get the process started because everything in India seems to require a working phone. She then checked at the dean’s office and...surprise, surprise...the letter was signed. She had not checked prior to my arrival that morning as she had claimed. I have learned that I need to be insistent and persistent bordering on rude in order to get things done. I took my letter and walked to the Airtel store that Julia had said to go to to get a SIM card. I was anticipating the worst at the phone place and was pleasantly surprised. The woman who helped me filled out my application for me to be sure that it was filled out correctly. She asked me for the names and numbers of (Indian) friends in Bangalore. I told her I had just arrived and didn’t know anyone. She said she just needed one name and one phone number. I pulled out my piece of paper with Dr. Sanjiv’s phone number written on it and wrote his name and number down. I also found my piece of paper with the guy I met on Thursday who bought my coffee and wrote down his name and number. She told me my SIM would likely be working by Saturday evening. I bought a simple Nokia phone and had the SIM card inserted and crossed my fingers that my application would be approved.

I walked back to the hospital and met Julia, Sandhya, and another German student Ruby for lunch at the hospital canteen. We then left for shopping on Commercial Street. Getting a rickshaw to take us to Commercial St. was a process. Some of the drivers didn’t want to go and others refused to use the meter. After about 10-15 minutes of failed attempts to find a rickshaw that would use the  meter (which they are required by law to use), we finally got one and made it to Commercial St. It is a busy shopping area with a combination of western and Indian stores as well as roadside stalls for market bazaar type shopping. Like everywhere in India, it was crowded with people, cars, and dust. Every store we walked into, we were immediately accosted by salespeople who stand uncomfortably close to you and try to help you shop even when you politely decline their help. There is great shopping in India but it really is an exhausting experience. Needing some comfort, we went to McDonald’s for lunch. I never eat at McDonald’s at home, but after being surrounded by the unfamiliar, I needed something familiar. I treated myself to fries and a Fanta orange float. While we were out shopping, I received a text message informing me that my application was approved and my phone was now working! We stopped for coffee at a Cafe Coffee Day and I was excited to try out my phone. I asked for an internet login after ordering (the sign on the door said free WiFi) and was told that they didn’t have WiFi. I started arguing - I mentioned that the sign on the door said there was WiFi. I was then told that I would have to pay 27 rupees for an access card to use the WiFi. I argued again stating that the sign said the WiFi was free. Not getting anywhere, I told the coffee shop worker to forget it. For every good experience, I have at least 3 frustrating ones...

After shopping, we headed back to the Annex III with the same frustrating arguing to find a rickshaw to bring us back to the hospital. We had about an hour before we needed to head out to meet up with Julia and Sandhya’s friends at the club.  

handwashing clothes :-/

The club we went to was a sports bar and there were soccer matches playing on every tv. The really nice thing about the bar is that they actually had free WiFi - WiFi that you didn’t need a password or a verifiable Indian phone number for! I did what I hate seeing other people do and immersed myself in my iPod - I checked emails, started sending IMs to people through messages. It’s amazing how dependent I have become on the internet for being connected. It makes it so much easier and I just feel closer to my friends and family when I am connected to the internet. After a while, I stopped being rude and enjoyed the company of my new friends. We had a great night. Bar close in Bangalore is 11:30pm which meant we got back to the Annex at a reasonable time and could get a good night of sleep.

This morning (Sunday), I decided to tackle getting my internet. I walked to the store in the Forum Mall that Julia told me to go to for getting the 3G internet stick. I was a little worried because I had foolishly given my only copy of my proof of address letter to Airtel the day before for my phone. Airtel was closed on Sundays so I was unable to get the letter back from them. Julia had not needed her letter in order to get the internet, so I was hoping that it would be the same for me. For 1000 rupees ($20), I could get the TaTa DoComo internet. At first I was told that I didn’t need the letter - that my passport copy, photo, and verifiable phone were enough. Then I was told that I needed the letter and would not be able to get the internet stick. I explained that I gave my letter to Airtel and that they were closed on Sundays so I could not get the letter back from them. I also explained that the person I needed to get another letter from at the hospital was not working on Sunday so I probably could not get another letter until Tuesday. I asked if there was any way around it. The sales clerk told me that if I got the Airtel 3G stick and paid 1500 rupees, I would not need the letter. Fine. More leeching of money. But it is oh so worth it to be connected to the internet in the comfort of my room! 

Final note for any of you traveling to India. When you go out to eat, you have to look at the menu because oftentimes large parts of the menu are unavailable at certain times of the day. Tonight Julia, Sandhya, and I went to eat at 5:30. Over half the menu was not available between 3:30 and 7. Also, it is not infrequent to go to a restaurant and try to order something only to be told that they are out. As Sandhya likes to say, it’s all part of the experience... Namaste.

Arrival in Bangalore

Thursday morning I flew from Delhi to Bangalore. As I have mentioned before, at the airport every person gets individually wanded after walking through the metal detector. You do not have to remove your shoes or even your jacket to go through the initial metal detector but after going through that, I entered a draped off room where a security official used the wand and patted me down. The wand went off on my right leg. I was wearing spandex work out pants so there was no way I was concealing anything. The woman asked me if I had had an operation...OF COURSE! My titanium rod in my right leg from when I had my osteotomy in 2008 sets off the wand metal detector. I told her that yes, I had a metal rod in my leg due to an accident I had when I was 11. She let me through. 

My flight was an hour delayed due to the fog in Delhi so I arrived in Bangalore around 1:30 in the afternoon and took a taxi to the Annexe III. Wizened by my weeks in the north, I knew about what I should be paying and when I couldn’t find the prepaid booth due to airport construction and poorly marked signage, I found a taxi company that would use the meter and paid 735 rupees for the 40km trip in. When I checked into the Annexe III, I was given a letter stating that accommodation would not be available for me from January 27 - February 10 because of “unforseen circumstances.” Well, unforseen they may be, but the medical college knew before I arrived that I would be kicked out in a week and didn’t bother to send an email to let me know. The alternate accommodation the medical college is offering is a sister hospital 20km away (which would take about an hour to drive in Bangalore traffic) and suggested taking a bus to and from there to St. John’s everyday. No way. I am really angry about this whole situation. Thankfully since I have arrived have found some new friends - a group of German medical students - who are trying to find something closer. At least I am not alone in my frustration.

The room is comfortable with working hot water, a desk, a dresser, and two twin beds that are reasonably comfortable. After unpacking my things, I headed across the street to the BDA complex to see about getting a USB internet stick. Due to “terrorism,” it has become really difficult for foreigners to get connected in this city. In order to get a SIM card which you need to have a working phone, you have to provide a passport photo, a copy of your passport and visa, as well as a proof of address. I am not even able to use the WiFi in the nearby coffee shop because to use the free WiFi login, I need a working verifiable phone number to receive a text verification code before I login to the WiFi. And to get all of this done takes time. Everything here moves at a snail’s pace and there are always more hoops to jump through (even more than in medical school in the US) and fees to pay. After my first day, I was completely frustrated and would have been happy to hop on a plane, fly home, and forget the whole thing in India.  

There are some really good things about India mixed in with the frustrations, but it is getting harder to separate the two. For example, while I was at the BDA complex trying to figure out who to ask to get an internet stick, a very nice gentleman offered to help me out. He had gone to college in California and lived in the US for 20 years before returning to his home in India. He was the one who helped me figure out all the things I needed to get in order to get a phone and internet. He then bought me a coffee at Cafe Coffee Day and gave me his email and phone number in case I needed any help. He knows what it’s like to be a foreigner in a new place and how nice it is to have people to help you figure things out. Unfortunately in India nothing gets figured out very quickly so my list of things that I was hoping to accomplish on my first afternoon in India was left without hardly anything checked off. I did manage to make it to the shopping mall (a really nice, quite large shopping mall that could fit in at any major city in the US) and buy some necessary items like shampoo and conditioner. I have little hope that I will accomplish more tomorrow. Namaste.

Back in Delhi

thali lunch

17 January 2012

I arrived back in Delhi Monday afternoon and met the cab I had arranged to pick me up from the airport to bring me to my hotel. My hotel for the final 3 nights in Delhi is in the same neighborhood as the last time I was in Delhi but seems to be in a busier and better lit part of that neighborhood. There is also WiFi available in the reception that was fast enough to support Skype phone calls without interruption and uploading photos at a decent speed. My room is kind of a dump. The bed is softer than my bed in Jaipur was but the sheets have some stains on them - I’m glad I brought my own to use. The door has a wide gap at the base which I don’t particularly like and it just overall seems like quite a rundown room. There appear to be nice rooms within the hotel but I am sure those cost more. I figured it was only for a couple of nights and I would be able to bolt myself into my room so it would do. I just relaxed on Monday night and got in touch with Bernie who was still in Delhi for one more day before heading back to Australia. We made plans to meet up on Tuesday morning at the Red Fort and do a bit of touring together.

Red Fort

Tuesday morning I got up and had breakfast then made my way to the New Delhi metro station. The metro station is on the opposite side of the railway station from where my hotel is and the quickest way to get there is to go through the railway station and over the tracks. It was a quick trip to the Red Fort in Old Delhi. As I got off the metro, I found myself again confused about which way to go to get to the Red Fort. The Delhi metro is nice and pretty clean, but I think it would be really helpful if they would indicate which gate to exit out of to get to the various historic/tourist sights. Perhaps they don’t anticipate that many tourists will use this system for transportation. Thankfully, I saw a couple of obvious foreigners and asked if they were heading to the Red Fort and if I could walk with them. They were two guys from the US who were in India for business and doing a little sightseeing before heading back. We walked to the Red Fort and I easily found Bernie at the entrance gate. 

Red Fort

The Red Fort was pretty similar to the other Mughal forts I have seen while in northern India. It was more impressive from the outside due to its massive size then from the inside. It was worth seeing but I had been more impressed with the Agra Fort and Amber Fort. I think if I were to do this trip again, I would cut out a few of the forts that I visited because I felt like once I had seen a couple, I had seen them all.

Next we took a rickshaw to Humayun’s Tomb in New Delhi. This tomb was the model for the design of the Taj Mahal. Unfortunatley the tomb was undergoing some restoration work so large green sheets covered parts of the tomb which took away some from it’s effect. I wish it had been a nicer day to see the tomb as that would have also added to the impressiveness of the tomb. Part of the problem is Delhi itself. The city is so hazy that I have rarely seen more than just a peek of blue sky. The haze also causes a lot of my pictures to look somewhat blah as well. It was still a beautiful and impressive tomb. The information section provided at the entrance of the tomb was very well done. The most interesting thing I learned was the reason for the beautiful lattice-work screens that I have seen in many of the tombs. Apparently, when Mohammed was being chased by his enemies, he hid in a cave and spiders weaved a web over the entrance of the cave to keep him hidden from his enemies. In this way, he was kept safe through the night. The screens over the windows of the tombs are to represent the webs of the spiders that protected Mohammed from his enemies. 

Red Fort

After visiting the tomb, we were quite hungry. Bernie suggested a place called Rajdhani for lunch that was mentioned in the Lonely Planet and is reputed to be a delicious place for thalis. Thalis are sort of a sampler platter of various Indian “curries” with unlimited refills. I put “curry” in quotations because curry is really a term the British used to lump the wide variety of Indian dishes together to simplify them. Each region has its own distinct “curry” using different ingredients and spices to provide a unique taste experience. Calling it all “curry” fails to distinguish between these individual dishes. In addition to the curries, you are given unlimited refills of roti or chapati to dip into the curries. For about $5, we had a fabulous and filling meal. After finishing the bottle of water that I ordered from the restaurant, I pulled out my own bottle which I had added Crystal Light to. One of the restaurant managers approached me and asked if I had brought alcohol into the restaurant. I told him no - that I had just added some juice mix to the water to give it flavor. From what I have read, it is really frowned upon for women to drink alcohol in public in northern India. It actually may be frowned upon for women to drink alcohol at all - even in private. I just hated to waste plastic bottles which is why I had pulled out my own.

Humayun's Tomb

Bernie and I talked about going to see the Qutub Minar as well for sightseeing but we were both a little tired of touring and wanted a more relaxed afternoon. I still had one more day in Delhi and could go to the Qutub Minar on Wednesday. Rajdhani was in Connaught Place which had some interesting shopping that I had planned to check out if I had time. We spent the afternoon going through various shops including The Shop, The People Tree, Fabindia, and Central Cottage Industries Emporium. I also finally found a copy of Lonely Planet South India. It was a pretty successful afternoon of shopping although I really don’t have weight and space room to bring much more to Bangalore. I’m hoping that once I get there, besides shopping for things I need on a daily basis, I won’t do much pleasure shopping. Otherwise I will have to figure out the postal service to mail some things home!

Qutb Minar

After shopping we were still full from lunch and so concluded our day with a coffee at Cafe Coffee Day. Both Bernie and I were so glad that we could meet up and tour Delhi together today. I hope we are able to keep in touch and perhaps when I make it to Australia, I can go to Melbourne and visit!

18 January 2012

Wednesday - my last day in Delhi and my last day of my two week tour of the Golden Triangle. I am definitely ready to be done touring and to settle in to a routine in Bangalore and actually start doing some work. It’s been a great couple of weeks, but I get tired of traveling and touring and not being able to unpack. My only plan for the day was to see the Qutub Minar and to meet up with Sarah when she returned to Delhi later Wednesday afternoon.

Qutb Minar

I spent the morning lazily - I caught up on my blog posting through my trip to Agra and called my parents. Just before noon, I left my hotel and took the metro to Cafe Coffee Day in Connaught Place to have some lunch. I enjoyed the quiet buzz of the coffee shop and did some reading while eating my lunch and drinking my coffee. After lunch, I got back on the metro and headed to Qutub Minar. At the metro station, I took a rickshaw the rest of the way to the historical site. The Qutub Minar is the site of the first city of Delhi after the Mughals took over during the 11th century. The tower itself was built in the 1100s and is made of red sandstone and marble like much of the Mughal architecture during their several hundred year rule over northern India. It has five stories demarcated by projections and intricate carvings and inscribed verses from the Koran beautifully decorate the minaret. It reaches a height of 72m. The tower itself was created as a tower of victory for the Mughal takeover of the region from the Hindu rajputs. It was started at the end of the 1100s but didn’t reach it’s current height until the last stories were added in the mid 1300s. Also part of the complex is the remnants of the first mosque in India which was created using pieces from Hindu and Jain temples and created by Hindu artisans. The original mosque was expanded over time and one Mughal emperor had plans to build a larger tower than the Qutub Minar but his tower only made it to 27m before construction stopped with his death. The ruins of this tower are a disappointing pile of rocks compared to the beautiful work of the nearby structures. Another wonderful example of Mughal architecture is with the tombs and the south entry gate. Made of red sandstone and marble with the beautiful carving work throughout as well as the very pretty lattice screens covering the windows, both the tomb and the entry gate are impressive to spend time looking at when you can take your eyes off of the Qutub Minar. 

Qutb Minar

The oldest piece within the complex is a 7.2m tall Iron Pillar. There is a Sanskrit inscription on the pillar which dates it to the 4th century. The Iron Pillar is a wonder because it has never rusted which apparently has baffled scientists because the technology of the 4th century did not seem to allow for rust-proofing iron. 

This was a great way to end my touring of the north. I felt like I had seen quite a lot and at a certain point it becomes difficult to really take anything more in. I made my way via metro to Sarah’s hotel in the hopes that perhaps her group had checked in early and I would get some more time to spend with her. I was in luck! Her group had checked in, and I asked the receptionist to ring her room for me. It was nice to talk about our adventures since we had last seen each other a few days before and also to talk about some plans. Sarah’s group was finally getting some free time to explore and she didn’t really know what exactly to do - there is so much in Delhi. I was so reliant on my guidebook to help me decide what to do and see and was very pleased with what I was able to accomplish so I gave her my suggestions based on what she and her roommate were interested in doing/seeing. We then went and had dinner together at a short walk away from her hotel then took the metro back. I was very excited about the matching rings with the “Ohm” mantra inscribed in them in Hindi that Sarah found for us at a market she had been to in Delhi. It’s nice to have a physical reminder of family on me at all times. I left to return to my hotel and repack all my things before having to catch my flight to Bangalore Thursday morning. We hugged goodbye. If I am not able to make it home in March, I won’t get to see her again until the end of June/early July :( It was great fun to be able to meet up in India and although we didn’t actually get to see any sights together, it was still fun to meet up and swap stories. I hope she has a great last few days in Delhi and a safe trip home! I look forward to joining her there in a few more months... Namaste.

sun salutation at Delhi airport

Agra - The City of the Taj Mahal

Sisters! at Cafe Coffee Day in Agra

Friday night I had dinner with Sarah at my hotel after she returned from her day of conference-ing and sightseeing. She was really disappointed as the plans for her group had changed again. We had both been really looking forward to seeing the Taj Mahal together in Agra and was the main reason I had come to northern India in the first place before heading to Bangalore. Apparently several girls in her class had been upset that they had not done much shopping up to this point in India. So instead of seeing the Taj Mahal and the Agra Fort on Saturday as was listed in their itinerary, they were going to go to Agra and spend the afternoon shopping then see the Taj Mahal early Sunday morning before moving on to Gurgaon. At this point my train ticket had been confirmed (I was off the waitlist) and I knew trying to change it the day before a trip would be quite a long shot. I was unable to change my ticket to Sunday as the waitlists for trains from Agra to Jaipur were quite long except for a train that left Agra at almost 11pm on Sunday night scheduled to arrive in Jaipur between 3 and 4 in the morning. And even on that train I was 5th on the waitlist. So I made the decision to still travel with her class to Agra in the morning then depending on the time we arrived, spend an hour or so shopping with Sarah before going to tour the Taj Mahal and the Agra Fort...alone :(

Interesting fact about 14 January - it is the day of the annual Kite Festival which is a Hindu festival that is celebrated all over India. Jaipur is supposed to be one of the best places to view the festivities but unfortunately because this was the day we were going to Agra, we missed the festival. The Kite Festival sounded a bit like the kite flying I have read about in The Kite Runner (excellent novel - highly, highly recommended). Thousands of brightly colored kites fill the sky and people compete to get their kite to fly the highest. The strings are coated with a special mix that includes glass shards so that kite flyers can cut down their opponents’ kites. Even though we missed the actual festival, we were able to see signs of it throughout Jaipur in the days leading up to it and in the days following. The sky was still filled with many kites as people practiced for the big day. Following the festival, kites were strewn throughout the treetops as the trees always won over the kites that came in contact with them.

Taj Mahal

I got to Sarah’s hotel around 645am and had breakfast with her before boarding the bus with the class to head to Agra. It was a very fast 5 hours bus ride as Sarah and I got more caught up and shared pictures from our respective trips. We rode in the back of the bus which I was grateful for because I didn’t have to see the dangerous passing game that occurs on India’s highways. However, being in the back of the bus also seems more like a crazy ride as any bumps we went over resulted in us being briefly airborne. We were given a lunch on the bus as well as a bottle of water. When we arrived in Agra, we stopped at a bazaar to do the newly planned market shopping. Neither Sarah nor I was impressed with the shopping scene at this bazaar although we were both so disappointed that we would not be seeing the Taj Mahal together that I think our judgement was altered somewhat. Not in the mood to shop, we sat down at Cafe Coffee Day (India’s version of Starbucks) and had some coffee/tea/milkshakes together. Sarah’s professors also stopped in and when they saw how sad Sarah and I both were to be unable to share the Taj experience together, they suggested that perhaps she go with me. This would have been great if we had gotten this go-ahead when we arrived. But as it was now after 1pm and my train was leaving at 630pm (and I want to arrive early since I was not sure how the train station system worked around here), we didn’t think we would have time to see the Taj and for me to get Sarah to their hotel (which we didn’t have an address for) before I had to make it to my train. In retrospect, it would have worked since my train ended up being delayed...4 hours. More on that later.

Taj Mahal

Both of us teary-eyed, we hugged goodbye planning to meet up quickly in Delhi Wednesday night before I headed to Bangalore. I caught a rickshaw to take me to the Taj Mahal. A little history lesson for those of my readers that don’t know what the Taj Mahal was built for: it is a tomb that was built by Shah Jahan, a Mughal emperor of India, for his third wife Mumtaz Mahal who died in 1631 giving birth to their 14th (yikes!) child. The tomb took many years to build and by the time it was finished, Shah Jahan had been overthrown by his son and was imprisoned in the nearby Agra Fort until his death. His son was kind enough to give his prison a view of the Taj Mahal so Shah Jahan could gaze at his wife’s memorial from afar. Shah Jahan is also buried in the Taj Mahal. This was the most expensive sight I have paid to see so far in India (750 rupess - about $12.50) but was worth every rupee. It is as stunning as everyone says it is and is so much more impressive in person than any picture can convey. It’s magnificence even made the crowds less bothersome. One thing I have learned about the Mughal rulers is that they have such an artistic eye for architectural detail. Everything is planned and meticulously executed to create these incredible structures. The walls are carved with beautiful designs (mostly floral) with precious stones inlaid within the marble carvings to provide them with color. This is why all the colors are still so magnificent after hundreds of years - they are the colors of the gems, not of paint. The Taj Mahal is elevated so that when one looks at it, the only thing in the background is the blue sky. It is simply breathtaking and no words or pictures can do it justice - you just have to see it for yourself in person.

Taj Mahal

From here I went to the train station to see how it was laid out and to try and figure out where I needed to go once it was time for me to wait for the train. The train station was a busy place with people everywhere - coming, going, waiting. I saw the official chart for my train and that I was on the chart (this is good - if you are not on the chart, you get kicked off the train and have to pay a fine). I couldn’t tell what the track numbers were, but I did find the display that gave the train information. Apparently the trains aren’t always named the same thing that is on your ticket so you have to look for the train number to figure out where you need to be. Feeling okay to leave and since I didn’t want to start waiting over 2 hours before my train’s arrival, I decided to check out the Agra Fort which was adjacent to the train station although the only entrance was on the opposite end of the fort. I didn’t have much cash left as the Taj Mahal was more expensive than I had anticipated. I was going to use the ATM at the train station but there were so many people around that I didn’t feel quite comfortable doing so. I got to the Fort (about a 10-15 minute walk depending on how fast you can walk), discovered the price was more than I had cash for, and went in search of an ATM. My search brought me back to the train station where I got some more cash then walked back to the Fort entrance. This was the most walking I had done in a while and it was nice to actually move about the city on my own although the neighborhood around the Fort was semi-questionable. I am glad that I took the time to go to the Fort even though I had to rush through it. It is a very well preserved fort with a  lot of green space. It is a beautiful example of the Mughal architecture incorporating both the red sandstone and the white marble with incredible carved inlay work throughout as well as impressively architectured gardens. Probably the best part of the whole Fort tour was the show I watched by the monkeys that lived around the fort. There were so many of them! I loved watching them chase each other and play games. They were quite funny to watch. The babies were super cute and watching the protective parent with their babies was very cool.  

Agra Fort

I made it back to the train station about 45 minutes before the train was supposed to arrive. I had no idea which track was track 1 (the one my train was supposed to come to). I saw a non-Indian family and decided to ask them where they were headed and if they knew how the trains worked. I figured at the very least, I would find some people to be clueless with. The family I introduced myself to was a family of 4 - both parents and two college-age kids. The parents and the brother were visiting the daughter/sister (whose name happens to be Elizabeth - although she goes by Liz) who had been studying for 6 months in Bangalore, has now graduated, and just recently got a job there. Great coincidence! I was so happy to have some people to chat with and to make a connection in Bangalore. The whole family was very friendly and Liz and I exchanged information. She offered to introduce me to people in Bangalore if I was interested (YES!). I was so glad I found people to wait with because the train ended up being 4 hours delayed. Apparently this is not typical - late is, but 4 hours is not. Shortly before the train came, we met another solo female traveler from Paris who was going to Jaipur to stay with a friend of hers. She was in India studying massage for a few months and was taking a break from her studies to travel around Rajasthan. The best part of traveling is the people you meet from all over. I have become much more outgoing because of my solo traveling, and although I miss having travel companions (especially for things like seeing the Taj Mahal), I have met some really great people as a result of my increased outgoing attitude. 

Agra Fort

We made up about an hour on the trip to Jaipur and arrived shortly after 2am (originally supposed to arrive at 11:10pm). I was immediately approached by a rickshaw driver as I exited the train and was glad to find my new friends to walk with to shake off the driver. Although I needed a ride, I am wary of drivers that are so aggressive in trying to get you to take a ride with them. Good thing I waited. Mag - the woman from Paris - was unable to get a hold of her friend even though she had been able to inform her hours before of our train’s delay. She had nowhere to go. I suggested my hotel as I had been very pleased with it and she tried calling but there were no rooms available. By this time, Liz and her family’s arranged ride from their hotel had arrived. None of us felt comfortable leaving Mag alone as we had by this point attracted quite a group of onlookers hoping to get us to ride in their vehicles and probably to take us to their hotels where they receive commission. I told Mag that I had a large bed and she would be more than welcome to spend the night at my hotel and figure out things with her friend in the morning. I could just imagine how I would have felt in her position - tired from traveling, in a new city that I didn’t know at all, with no place to go at 2:30 in the morning surrounded by strangers. She accepted my offer and we got a taxi together to my hotel. We both fell asleep quickly and got up the next morning not exactly refreshed. Mag was able to get in touch with her friend and we parted ways after having a lovely breakfast in the outside garden and sharing names and email. I now have a friend in Paris with whom I am welcome to stay with whenever I happen to return there to visit! Namaste.

Agra Fort

Agra Fort

Agra Fort