I started today like every other day but today is my day off.  Normally my day off is packed with errands to run, things to get finished, and time to socialize.  Yesterday I thought to myself, what am I going to do? What I didn't anticipate was socializing today.  In the staff quarters/guest quarters there is an Indian-American woman who is staying here tending to her father, who is ill and admitted to the hospital.  She left the area over 25 years ago and settled in Arizona.  My new friend tried to get her father to move to the US  but he insisted on staying in the land where he grew up and where his circle of support lies.  Now her father is 86 years old and has been hospitalized since January 7.  He was planning to move to the US at the end of March and wanted to get any major medical procedures completed before leaving.  Any surgeries would be too expensive in the US and his insurance won't work there.  He was admitted for an umbilical hernia repair and has had several complications since then.  Doctors found a hair line hip fracture, which they will not surgically repair due to his age, plus a hematoma (a pool of blood in the tissue).  His latest ailment is that he is constipated. During my intern year, I was an expert at constipation. I had a full arsenal of remedies to make the bowels move.  Here however, it turns out the pharmacy doesn't have senna, colace, docusate or Miralax (stool softners and laxatives). The town pharmacy doesn't even have them.  My friend is incredibly frustrated because if she would have known, she could have filled her entire suitcase full of these over the counter medications with one stop at Costco.   

I went to visit her dad today to show him that his daughter has a friend here and is staying strong.   My first surprise was that he is in the special VIP ward which means he can pay the 700 rupee a day charge for a private room (approx. $12).  It is very similar to the hospital rooms at Wake, minus the sailboat picture on the wall, air conditioning, and there is no flat screen TV.  My friend has hired an aid to be with her father 24/7 as an extra measure because here the patient attendants have the responsibility for all the needs of the patient.  There isn't much I did for her father expect offer reassurance and support.  Hopefully he will get well enough soon to make his flight to the US.  

The rest of the day was spent recuperating.  It seems that I have caught a type of cold virus.  Yesterday it started with my left eye watering and a runny nose. Today it progressed to congestion, headache, and a few muscle aches.  Nothing very serious just a bit of an inconvenience.  There are numerous people with the same type of symptoms and I was told it should only last a couple days.  Keep your fingers crossed! 

The guys taking care of me we excited to give me a taste of America today for a Sunday treat, Diet Coke.

I think OPD stands for Out Patient Department.  It is ward number 7 on the ground floor just steps away from the main entrance to the hospital.  (Aside one thing I like about this hospital is that the numbering actually makes sense including the floors as ground 1, 2, 3, 4). Back on track, the outpatient clinic teams for Internal Medicine are rotated on a daily basis.  There are 6 Internal Medicine Teams so therefore each team spends one day a week in the outpatient clinic and causality (the ER).  That is the day they admit patients to their ward service then the rest of the week they take care and discharge until their admitting day rolls around again.  The Professor explained to me how the patients who come to this clinic or hospital are the rural, poor, and very sick.  Those with means or in cities go to the private hospital where they can make appointments and don't have to wait to be seen.  Here, however, that is not the case.  Many of the patients we saw this morning and afternoon were text book illness such as tonsillitis, chronic liver disease, sciatic nerve pain, Rheumatoid arthritis, and low platelets.  Yet the diagnosis and treatment were more like a puzzle and negotiation.  You see part of the diagnosis and treatment is trying to figure out one the means of the patient, two what investigations fit within those means, and three how serious is the illness that you need to push the patient's outside their financial comfort zone. Evidence-based medicine is still the foundation of knowledge and desired practice but in reality if  you don't have the gold to pay for the "gold standard" what value does it have?  

I admire the Professor in her drive, negotiation skills, and perseverance when practicing medicine.  To me I feel she has the patient's best interest in the forefront, even if is not something they want to hear. She tells them this is what would be needed and then tells them what is a must.  They trust her and in return, she does what she can to do right by them.  There was a time sitting in clinic today where it was as if I was in one of the resident clinics back in the US, just the surroundings and dress was different.  There have been several times during my residency where a treatment or study has been prescribed but later find out it was not completed due to cost.  I face this problem more and more while practicing medicine in the United States. We often must manage finances, not medicine.  I think the main difference is that here in India there is transparency of the costs for labs and medications.  In the US it isn't until your insurance is submitted that the cost is determined.  At least in India you know up front what your costs are and if treatment will be financially feasible.  Of course that being said, I am impressed with the resources available to patients in the US, if cost IS an issue.  There are community pharmacies and crisis centers that will provide medications without charge. 

Stepping away from medicine, Professor and I spent the downtime between patients talking about the cultures and traditions of our respective countries.  One topic that came up was marriage and weddings.  She was surprised that there are not really arranged marriages in the US.  This to her was the way it should be, marriage revolving around love between two people instead of being told who you are suppose to spend the rest of your life with.  She was also surprised that there is no dowery in the American wedding culture.  We talked about the traditionally the bride's family pays for the wedding and the groom's family pays for the reception, that is as close to dowery and gifts I could come up with. We also talked about Ruby, the new puppy my sister and I gave to my Mom as a surprise early birthday present.  Professor talked about how she never understood American's attachment to domestic animals until she read the book Marley and Me.  She states she was weeping by the end and it made more sense to her how important pets can be.  Still though, she won't go to her brother's house if his dog is there. 

I truly enjoy these chats with the Professor on more of a person level. I came to India as a representative of Project HOPE in the field of Medicine.  However, this journey is more than medicine, it is fundamentally about the people and culture.  The rest is built on those two things. How blessed I am to learn about the culture and people by being immersed in it with such willing teachers.

Below is the Medical College and Dorms.  The view is from a balcony at the hospital near my room.

Today I was mid chart review when an assistant approached me and beckoned me to follow him.  He looked official in his wife uniform so I went ahead and tagged along.  We ended up in the Medical Superintendent's office where Professor was with several other people.  There was pit in the bottom of my stomach, what did I screw up or what cultural faux paus did I make.  Instead, I had the pleasure of meeting several administrative gentleman. I can't remember their names but one was the head of the Internal Medicine Department the other the Head of Surgery and I have no idea who the third was.  They heard I was at the hospital and wanted to meet me.  It was entertaining watching them interact with each other and then trying to interact with me.  The head of medicine gentleman had such a thick Indian accent I had to let the Professor translate for me.  We then spent 20 minutes trying to explain how college and medical school works in the US.  It is confusing in the US to figure out medical school , internship, and residency.  I can only imaging how much more confusing it is for them!  Then they asked me how much medical care costs in the US say for an office visit. Good luck figuring it out. My honest answer of it depends didn't seem to satisfy them. However I don't exact numbers it depends on the region, the hospital, your insurance company, if it's raining outside ( just kidding). Transparency is yet to be a staple of American medicine from my point of view. We had coffee and there were several side conversations that took place.   In the back of my mind I am always wondering, are they talking about me and if they are I hope it is good.   One thing is that I don't find myself dwelling on that aspect, so what if they are talking about me.  Let them talk.

An interesting conversation that did take place was about the passing of law to split Andhra Pradesh (the state in India I am in) into two different states.  In India the land is divided into states based on the linguistics of the area. This new split from what I can gather was based on politics.  The big uproar about the split is that the new state will include the current capitol of Hyderabad.  The people in this area feel they have spent their time, money, and resources to build up the capitol and now it is just being given away to start over anew.   (Keep in mind this is my very rough translation of the events, please correct me  if anyone knows more)  One thing I can say for sure about India, the people are passionate for their country and passionate in their conversations!  There is constant action when talking whether it is the tilting of the head side to side or waving of the arms, it is constant action when carrying on a conversation. I may not be able to understand the words but I stay entertained. 

The now previous state of Andra Pradesh.

I have to say each day I fall into more of a routine and things seem to be improving. I had my morning coffee followed by a cool  shower then breakfast.  I was able to get some Skype time in with Mom and even catch the end of the Mizzou basketball game before it was time to round.  Today on pre-rounds I branched out from just watching to participating.  I went with the House Surgeon (Intern) and examined the patient along side her.  It is interesting to hear the lung sounds and then hear them described in different vocabulary.  It takes me a minute to make the translation.  When I was listening to the lungs of a woman I placed my hand on her shoulder, like I wound any other patient.  What happened next surprised me, her mother every so timidly stroked the back of my hand.  I wish I could have known what she was thinking.  While that was happening the daughter on the other side of the bed was taking my picture with her cell phone.  I caught her in the act so to speak but just smiled for the picture.  Part of me feels like such an imposter because this family was looking at me to figure out the diagnosis.  However, you could be the smartest doctor in the world yet in this situation the socioeconomic factors limited your diagnostic abilities.  There is a strong clinical suspicion this patient has lymphoma yet without solid proof you can't treat her appropriately.   In the end it was recommended she see further treatment at an institution in the larger city of Hydrabad that has a hematology department. We will see tomorrow if the family agrees to this because they are poor and may not be able to come up with the money.  The Professor reminded than that once they get the diagnosis they can come back here to complete their treatment.

Another experience on rounds that stuck with me today was when we were getting pimped by the Professor (this is a form of teaching where the superior asks you questions that you are expected to know and if you don't you are scolded).  She was asking about Dengue Fever manifestations and classifications (luckily I was not part of the questioning on this particular topic because that is not an illness I am familiar with).  The residents did not know all the answers in regards to the pathophysiology, that is when the Professor made this comment "Your eyes see what your brain knows". Implying that if they didn't know the manifestations they wouldn't be able to diagnosis the symptoms if a patient presented with them.  For me this resonated in how true it is.  There are time when I get reliant on resources or smart phrases, watching this morning gave me the urge to buff up on the foundation to better serve the patient's I see. 

After rounds I had the pleasure of my mid morning sit down time with the Professor.  This is the time we go over the topic she assigned me the previous day and really just exchange cultures.  It is fascinating to me how from first glance India and America seem like polar opposite but then after discussing issues I realize that they are actually more alike than I thought.  Yes there are inherent differences due to the population size of India and the variety of cultures, languages, and poverty however, people at their cores are strikingly the same. From the little things like in both cultures as a single woman over the age of 22 there is the barrage of questions about when are you going to get married to society revolving around money as the marker for success to even the lack education and literacy perpetuating the cycle of poverty.  Two different countries but as humans it appears we all share similar traits.

My room that even has WiFi!!

Today I arrived for rounds at 9 am on ward 31.  I looked over the charts, for the most part which are written in English and examined a few patients.  I watched as one report showed a Cr of 2.5 meaning the antibiotic they were using needed to be reduced because the patient's kidney function was decreased.  What I saw made me appreciate and realize how lazy or perhaps efficient medicine in the US has become.  If I need to renally dose an antibiotic I go online to UpToDate or MicroMedX  to find the dosage.  Then if I'm not sure I can call the pharmacist just a phone call away to further clarify to dose.  Here what ensured was pulling the medical information insert out of the box of pills, reading the instructions, doing the calculations, and finally determining the dose.  This entire process took 15 minutes in all whereas I would take less than 1 min, 5 at the max if I had to call. 

This made me reflect how medicine in the US is very instant, we want results and we want them now.  Once the results come we want action to be taken immediately.  It seems like there is always a test or image to follow up on and the care plan for patient's is dynamic changing moment by moment.  Perhaps that is why I struggle when patients, families, nursing staff, administration and even attendings ask when something will be done or when the discharge will take place.  I can give a rough estimate but in reality I'm not very accurate at predicting the future. That being said all I ask for is patience and understanding when I predict the wrong time, the wrong date or discharge a patient past 1 pm.

Moving on rounds this morning were incredibly brief.  The woman with pancytopenia, fevers non responsive to antibiotics, and now crackles with associated hypoxia on room air is still ill.  She refused to go to the bigger city, Hyderabad, for a second opinion on her bone marrow.  The marrow read here was reactive but her clinical symptoms and lab studies seem to be consistent with a hematological (blood) malignancy.  That leaves the Professor with a tough decision on calculating her next move.  More to come on that tomorrow.  The remainder of the 7 patients were seen quickly with new changes in management (except the dose decrease in the antibiotic).  

After rounds the Professor took me to the Cardic Cath lab where her husband is a cardiologist.  I was able to observe and interact with the cardiologist to see how evidence based medicine is modified under socioeconomical restraints.  The hands of the physician's are tied when it comes to their degree of practice, they have the ability to perform what the guidelines say but if the patient can't afford the medication after the procedure the "gold standard" is obsolete.  The case I observed was an elderly woman with three vessel disease and an EF of 20-25%.  The CT surgeons AND the patient were not willing to accept the risks of bypass surgery.  This left the cardiologist to at least perform a palliative stent to the RCA to help with her symptoms. The stents they use are bare metal stents.  When a patient gets the procedure the government will pay for the procedure and one year of medications. After that the patient is on their own.  Another fascinating aspect of the cath lab was when I walked into the back room to put on the lead jackets to avoid radiation exposure, there were woman on the floor with medical equipment spread on a blanket.  There were syringes, catheters, guide wires, and instruments.  Then the explanation followed...due to cost they have to reuse the medical supplies 4-5 times each.  In the US the supplies are discarded after the procedure even if they weren't use.  This is due to reducing the risk of infections.  However here supplies are limited and valued.  These woman spend their days cleaning and sterilizing the materials in order to give the patient's to opportunity to have a cath performed.  The cardiologists use more femoral approaches than radial because the supplies for the femoral access can be reused 4-5 times instead of 2-3 like the radial supplies.  Perhaps the risk of infection is the chance they have to take to survive.  Who I am to judge.  Although when I was in the OR, people were wearing open toe sandals, masks below their noses, the x-ray operator was on his cell phone, and the cardiologist "sterile" gown had a hole in the sleeve. I'm sure the infection control people from the US would have a heart attack had they seen this procedure suite.

Map of Hyderabad

I was up and ready to start my first day on the wards to meet the "professor medium" aka attending and participate in rounds.  I returned to ward 31, which is the female ward where the team is stationed.   I observed the morning pre-rounding and waited for the professor medium to arrive.  What I saw was the "House surgeon" aka intern seeing her various patient's and she was the one responsible for taking their vitals.  There is this blood pressure cuff box which the top flips open to become your gauge and the cuff is inside.   Then she uses her watch to count the pulse.  There is no dynamap to roll from room to room or even individual BP cuffs for each patient. Also there is no hand sanitizer between each patient's bed.  The house surgeon simply turned around to the next patient.  It really is amazing what you can learn from simply observing.  

Not too much longer I was directed to the office of the Professor Medium.  Her office is  a small room with a desk and plastic chair which I sat in.  Much to my relief she spoke English and an understandable English at that.  My first impression was that she was a fierce, intimidating woman who knows how to be in charge.  However, I have to say my first impression, as most first impressions are, was incorrect. Yes she is perhaps a little more blunt that I'm used to when meeting people for the first time but I really like her.  The meeting started out with explaining what year in residency which takes a good 10 minutes because the training tracks are much different between the US and India. After that the really interesting conversation took place.  She explained to me her passion for medicine and why she is at this hospital. Professor explained that this is a private tertiary medical center where the sick come when they have exhausted their other means of treatment.  She explained how India is a spiritual country and there are many different paths of seeking treatment besides allopathic medicine.  There is homeopathic medicine and Ayurveda (Indian Herbal medicine).  Professor isn't a fan of most of the Ayurveda practitioner's, her name for them is Quacks because she feels they take what little money the poor people have then when they get the money they want they refer to the hospital for treatment.   By the time they are referred to allopathy their diseases are far advanced. The poor patient's aren't educated so therefore they don't their rights.  They lack civic sense for example they see 7 children as 14 working hands but really turns into hungry mouths to feed.  These children are then the slum kids, whereas if they only had one child they could be ok.  Most are daily wage workers so each day in the hospital means no money for their families to get food therefore many times  the patient's state their discharge date. In regards to fees the hospital doesn't charge for admission but they have to charge for investigations (labs, test, imaging) that are expensive.

The professor spoke how the patients view her as a "God-like" figure.  What she says goes and they don't question.  Therefore it is her job to best determine how she can treat them.  The core of her practice is "ask, ask, ask" because the answer lies within the patient and not always on the investigations.  She asks the patient's their professions so she can gauge what they will be able to afford and perhaps what they can't.  She has a list of labs she wants to get but has to prioritize which are imperative.  If she spends their money on labs they won't be able to afford the treatment.  She could go work in the bigger cities and treat those will money who can afford the studies and medications but will also question her every move.  Yet she chooses to stay here with the poor because they too need an advocate and treatment.  Her view is that her God blessed her with the capabilities to treat the "children of the lower God". 

My morning coffee which is really sweet and tastes more like a mocha. Not a bad way to start off the morning!

I got up in time after a long restful sleep to attempt a "shower" which means turning the heater on for 5 min then filling a bucket with hot water.  I tried that and ended up filling my bucket with luke warmish cold water instead.  It still worked the same just not quite as enjoyable, it actually felt kind of nice given it's warm here. I used my new bug soap bar and even a shampoo bar both of which I am impressed with how well they worked.  I barely got out of the shower and dressed before there was a knock on my door.  There was coffee waiting for me and breakfast soon after.  The coffee here is sweet sweet sweet especially for a girl who is used to black coffee.  Breakfast was made american style and consisted of scrambled eggs and french toast. Both were again sweet but delicious. I appreciate the gesture towards familiar foods.  The awkward thing was that I was sitting at the table alone and hosts just stand there watching me. I guess they want to make sure I am enjoying to food, I'm just not used to all the attention.  I finished getting ready then it was time for the introductions to begin.  

I was to meet the medical superintendent of the hospital and some other staff.  It was a strange encounter because the medical superintendent  wasn't sure what role I am to play.  It was like this was suppose to be planned out for me not the other way around.  He didn't even know I was a resident.  I had to write out a mini resume for him to get that I graduated from medical school.  Then off to the wards which was a bit scary at first, I'm not going to lie.  

The assistant professor who picked me up spoke English to me which was great.  The only problem with that is she doesn't speak English to others so I still have very little clue what is going on.  The carts are written in English which allows me to under stand what has happened to the patient's at least.  I can figure out the general disease and treatment plan.This afternoon was pretty much just watching and observing how things worked.  

Patients are divided man and woman then admitted to the appropriate gender specific unit. We were a general medicine woman only ward.  There are just single beds lined up in rows with small stools next to the beds.  The stools are for patient attendants which are comprised mostly of the patient's families.  The attendents are not employed by the hospital and are relied on for the patient's basic care including toileting, bathing, feeding, walking, ect.  When the doctors see the patient they give the attendants a prescription which they then have to take to the pharmacy to get it filled, cost paid up front.  The attendants are the physical therapists, the nursing assistants, and the patient advocates.  The "orders" placed in the morning are recommendations for the attendants.  That being said there is a woman who from what I gather is employed by the hospital.  She is in charge of sweeping the concrete floors then mopping them with a rag.  The floors are clean after she is finished.

Orientation was a world wind of activity and I'm not sure how much orienting I received.  I was able to find my way back to my room which was a big achievement for the first day. Tomorrow will be the start of rounds at 9 am and meeting the Chief doctor for the unit.  I have my fingers crossed because I'm not sure what to expect.

Stepping of the plane in Mumbai there is indeed a unique aroma one can appreciate, as if someone forgot to take out the trash.  I can't say it is the most appealing up front but quickly you become accustomed. The airport was impressive to say the least. There was art integrated into the concourses and the immigration gate took less than 10 minutes.  Perhaps that was because I was traveling with others who had India passports along with their USA passports.  The magnitude of people in the airport was unbelievable for midnight.  Being an international hub there were planes for Europe, Singapore, and surrounding countries. Baggage claim was hub of activity with hundreds of people waiting to claim their bags.  It took awhile for our bags to arrive not before there were thoughts of what is the  luggage is lost, then what do we do? They did finally arrive and we were off to meet Vivek's Uncle. On the way out we exchanged money, approx 1 dollar is 57 rupees, some places the rate is even as high as 62.  As we left the airport there was a crowd of people ready to swarm on those in need of assistance with bags, transportation, or direction. Then through the crowd Vivek spots Uncle.  They reunite as friends who haven't seen each other in years but don't miss a beat.  All I can do from the sidelines is observe because I have no idea what they are saying.  We then went to the car, which Uncle has his neighbor drive because driving is an art in India, and loaded up the trunk.  With that we were off.  The city of Mumbai engulfs all your senses from the not to pleasant smells to the stimulation of the lights and sounds as we traveled through the city.  If you didn't know what time it was you would never have guessed it was close to 2 in the morning. People were out, traffic was flowing and the  hustle and bustle of the city was in full force.  Of course the travelers must be fed so we stopped at what you could call a rough version of  a drive through.  A guy standing on the sidewalk outside the restaurant where you place an order from the car then they deliver the food car side when it is ready.   Unique way of doing things but hey it works.  We navigated our way through the streets until we arrived at Uncle's apartment.  I can't explain how thankful and appreciative I was for him and his family. They opened their apartment to us and even made sure we were fed.  We sat down around a table and ate the authentic Indian food served by Uncle's wife.  It was delicious and filling however, if you clean your plate more will magically appear until you are so stuffed you can't eat any more! After the meal we sat around and "talked" aka I watched.  It was fun to see families catch up and  update each other on their lives.  The Uncle explained how he recently had a stent placed and showed all his medicine to ensure he was on the right treatment.  While this was going on Uncle's wife drew me a hot "shower" which I was grateful for.  After traveling for so long it was great to clean up.  This version of a "shower" is hot water heated then filled into a bucket.  You use a cup in the bucket to pour the water on your body and clean up.  Not what I'm used to but it works just as well.  Clean, fed, and relaxing with new friends will leave a lasting impression of Mumbai in my memory. These people were strangers to me only hours before but genuinely embraced me as family for the evening.  To that I owe them many thanks.

I should first say that I am not traveling alone for the first part of my journey.  Two wonderful friends I have had the pleasure to meet and work with in my residency program are also completing an internal health elective in India during the same time period.  Vivek and Ajay have both visited their families in India so are familiar with the travel.  The only down side is that they are not going to be in the same region of India.  The bright side is we were able to book our flights together from Charlotte to Munich to Mumbai.  Once in Mumbai we all were spending the night with Vivek's Uncle's family then I was back to the airport to take two more connecting flights to finally arrive in Vijayawada.  

The highlights of traveling with my brown buddies: First I was ready to be picked up at 1200 on Friday, they arrived at 1:00 pm.  This was only the first of our struggles with time.  I had the opportunity to meet Vivek's Mom and Dad who were driving their car down to Charlotte so we wouldn't have to leave a car at the airport for a month.  They are lovely, genuine people who obviously care dearly about their son and there for any of his friends too.   We made it to Charlotte and grabbed some dinner before our flight boarded.  Then we proceeded to wander the concourse looking for headphone splitters and camera connects, standing in awe at the Best Buy vending machine. What we didn't account for was the boarding time of our flight.  We arrived at the gate just as we heard Vivek's name announced overhead as the final boarding call.  I have to say it wasn't bad not having to wait in line but man we cut it close!  The three of use were in row 41 which is only three seat.  I was between the boys and we had a great time.  We watched the movie Captain Phillips simultaneously on the seat screens and talk about an intense movie, especially during happy hour.  There was an intermission for dinner then after movie cordials. I guess it pays off to befriend the flight attendant.  Before we knew it we were arriving in Munich to catch our next flight.  It was a bit early to explore the beer garden (8 am their time and approx 3 am in NC time) but a morning stroll to stretch around the airport was enjoyed.   Of course we felt right at home with Winston Lounges everywhere (aka smoking lounges).  Then  it was time to board our final leg together Munich to Mumbai.  We were on time for this boarding call.  Probably one of the highlights of the flight was the free WiFi !! We were able to download free talking, video, and text apps so we could stay connected on our travel with each other and with everyone back in the states.   I have to say times are much different from my first study abroad experience in Mexico when the internet was still dial up and only available in the school computer lab. 

My adventure actually begun in Feb 2013 when I applied for a scholarship to participate in an international health elective.  When I found out I was the recipient of the scholarship I was ecstatic!!   What an amazing opportunity to explore the world and learn medicine from a new perspective.  Then I learned my site would be in Vijayawada, India.  My first thought was that I could not correctly pronounce the site name much less know where in India it is located.  With the help of my trusty side kick, Google, I learned about where I was going.  Also I decided to ask around to see if any one had heard of the city.   The reactions and responses I got were not those of shared excitement.  They were statements such as really? Is that safe?  I don't think you should go.  You will stick out that may not be a good idea.  I was a bit taken a back by these responses.  I was even more taken aback when it was from people who had grown up in India or those who frequently visited their families in India.  Then there was the CNN story about the troubles of foreign woman traveling in India.   All the negative cautious comments gave me more motivation to prove people wrong.  Before I have even set foot on India I have done what I can to make sure my travels are safe.  I hope that the people I will be working with and encounter in India will be kind, welcoming, and friendly as those Indian individuals I know in the States.  That being said I am going to do everything in my power to respect the cultures and traditions of my host country.    If I'm honest I will admit I don't agree with all the views or customs but is it my place to bluntly disrespect them to prove a point? No. My mission is to experience the health care system in India through learning and teaching.  I can't deny I'm nervous and outside my comfort zone but these types of experiences challenge my strength, independence, and influence the woman I am both today and in the future.

P.S I have to thank Project HOPE for providing me with opportunity and scholarship.   Here is there website, check it out! http://www.projecthope.org/