Sunday, January 22, 2012

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.

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