A Little Bit on the Lady's Leg

Elephantiasis-Lymphatic Filariasis

Elephantiasis is chronic lymphoedema from a chronic lymphatic filariasis. Lymphatic filariasis is an infection of the lymphatic system by nematode filariae. It can cause enlargement of entire legs, arms, genitals, vulva, or breasts in addition to damaging the kidneys and lymphatic system. It is caused by one of three different species of nematodes. Majority of cases are caused by Wuchereria bancrofti, but B. malayi and B. timor may also cause this infection. LF can be a severely debilitating and disfiguring disease. It affects over 120 million people in over 80 countries in the tropics and sub-tropics. According to the WHO one third of all cases are in India, another third in Africa, and the remaining third in South East Asia, the Pacific, and the Americas.
The disease is transmitted by the bite of a mosquito. Mosquitoes feed off a person with microfilariae in their blood. From there the microfilariae develop into the infectious form and migrate toward the biting parts of the mosquito. When the mosquito feeds next the larvae are transferred to the person. The filariae reside in the lymphatic system and produce microfilariae that circulate in the blood. The parasites have a “nocturnal periodicity” and can only be seen in blood that is drawn at night. In the past this made diagnosis difficult but today an antigen detection test is done to determine the presence of parasite antigen in the blood which does not vary with time of day.
The presentation of LF can vary greatly from an asymptomatic infection to a debilitating/disfiguring disease. The variation is due to the reaction of the individual’s immune system and the parasite strain. Clinical symptoms are a result of local inflammation and immune response in addition to the direct damage of the parasite to the lymphatic system. The clinical features present both acutely and chronically. Acute features include filarial fever, limb lymphadenitis/lymphangitis, and epididymo-orchitis. The fever lasts three to seven days and is accompanied by chills, rigor, arthralgias, head ache, and sometimes delirium. The lymphadenitis/lymphangitis is extremely painful and can form abscesses. Epididymo-orchitis is the most common presentation and may also be accompanied by scrotal oedema and or hydrocele.
Chronic LF represents the cumulative effect of the disease and its progression over many years. There is some overlap between the acute and chronic states. Hydrocele may also be a chronic condition. It should be noted that multiple tapping of the hydrocele can yield to fibrosis and abscess formation. Chronic lymphoedema, otherwise known as elephantiasis, is common. It often affects the leg in an asymmetric manner. Grade I is transient, pitting edema that is relieved with rest and elevation. Grade II is oedema, non-pitting, and the skin becomes brawny. Grade III is characterized by lymphoedema. The skin becomes thickened, hyperkeratotic, and papillomatous changes occur. Chyuria and lymphuria may also occur due to rupture of damaged lymph from the intestines or other organs into the bladder or renal pelvis. Chyuria can cause malabsorbtion and both can cause urinary obstruction.LF is treated with one dose of albendazole and either diethlycarbamazine (DEC) or ivermectin. In some high risk endemic areas whole communities are treated annually to prevent spread of the disease with the above two drug combination. Another method of prevention in endemic areas is fortifying table salt with DEC. An important principal in managing LF is to prevent further progression of lymphoedema. Much of this is done by preventing bacterial/fungal super-infections and promoting/reestablishing lymph flow to affected areas. This can be accomplished by good hygiene to limb and nails, raising the affected limb at night, exercise to promote flow, and early treatment of wounds and abrasions. Collateral channels will open if infection is prevented. Chronic hydrocele maybe treated with surgical excision. Although LF can be extremely deforming and debilitating it is a preventable and treatable condition.

CHAD

It's been quite a while since my last post and so I will have to enter a couple entries together. Last week I worked at CHAD (community health and development). CHAD is a part of CMC. The goal was to have a community hospital to offer basic care to those who couldn't afford to come to the main hospital. In addition, they provide service to people living in the surrounding villages who cannot make it into the center of town. In total they cover 63 of the surrounding villages. CHAD has many different programs. There are many different aspects of CHAD; it is a hospital, an outpatient clinic (actually many different outpatient clinics), it holds doctors and nurses rounds in the local villages, there are patient educations sessions, and it also has community development projects (like skills training, daycare centers).
CHAD's website if you want more info: http://www.cmch-vellore.edu/departments/services.asp?did=6

This past week I took part in the outreach activities for CHAD which included doctor and nurses rounds. I can't remember the exact break down but I'll try to make it made sense. So for each village there is a part time health community health workers (PTCHW) who is a local village women. The PTCHW is then under the supervision of a health aide who is also from the village and I think covers 1-2 villages. They then under supervision of a community health nurse who covers multiple villages and monthly a mobile doctor led clinic will go out to visit these areas. During nurse rounds the community health nurse goes out to visit 3-4 villages. She meets with the health aide and PTCHW in the village and they let her know the patients that she needs to see. Each patient is seen at their own home. Most of the the care is antenatal/postnatal visits and chronic medical problems treatment The nurse also visits the Balvadis (I have no idea if this is how you spell it but it means daycare). Patient education is also a very big part of nurse rounds.

Doctors rounds are a mobile clinic that goes to the village and then the patients come to the mobile unit. Inside the bus is an area where the doc sees the patient with a patient table and the other half of the bus is set up for a pharmacy and is also where the nurse gives vaccinations. The last part of the clinic is outside and is a table where the intern sits and sees the patients they only see the doctor if she has any questions about what to do. The doctor also sees the antenatal patients. The cutest part of the clinic though this the scale they hand from a tree to weigh the babies in. It is a little pouch that they lay the babies in with a scale attached. It is the cutest thing (sorry, I didn't get any pictures).

I didn't see anything really crazy to write home about. We saw quite a bit of diabetes which I was surprised about at first and then someone told me it had to to do with the diet of the people here and the it completely made sense (lots of rice and other carbs). We saw your regular hypertension and surprisingly there were quite a few cases of epilepsy. I'm not sure if it is more common here. I think it is just that the people who come to these clinics are the people who require long term medications rather than the general population. Rheumatic heart disease is more prevalent in the population and so there where quite a few patient we saw with this condition and we got to hear a few murmurs.

The best part though of doctors rounds was weighing the babies and playing with super-cute kids.

Nurses rounds have been one of my favorite parts of the trip and so they deserve their own special blog...more to come later.

On a less academic note.... Another cool think we did during last was visit the Golden Temple. It is a pure 24carat gold Hindu temple on the outskirt of Vellore. We were told that the best time to go was right before sunset. So a group of us headed out there in the evening. You cannot bring your camera so I don't have any pictures :( In addition to no camera you cannot wear any shoes. This of course makes sense because it is a temple but you cannot wear shoes any where on the property. This meant no shoes from the time we entered the gate. Once you entered the gate you had to check your bags and then you had to go to wait in line to be let into the temple. Luckily the line was "short". They basically have theses cages with chairs. They fill one cage up, and then shut the gate and then open the next cage and start filling it. They then open the door to one of the cages and let that group out there is a waiting period and then the next group is let out. And since it is India it there is tons of pushing and everyone is all up on you. It reminded me of the movie "Children of Men". The temple gardens were beautiful. There was a path that encircled the temple in the share of a star that you had to follow around. The whole time you could see the temple as the sun was setting and the mountains behind. It was really incredibly beautiful. Although knowing the poverty that surrounds it makes you a little sad although they said they spent all this money on the gold so that it would bring in people and would provide money for the community...hmmm.
Pic 1: the bus for doctors rounds
Pic 2: Nurse Blessing at the pharmacy window with all of the different drugs they hand out.
Pic 3: Colin and Blessing trying to keep a baby from crying before she gets a shot.
Pic 4: Cute kids. The little girls in the white was hilarious. She would imitate everything Colin said down to his facial expressions. It was so cute and we got some great video of it.
Pic 5: A little girl and her mother with black dots on her face to protect her from the "evil eye"
Pic 6: Me (in one of my India tops) and this girl who followed me around the entire time we were there. She didn't really speak English and I speak only a work or two in Tamil.
Pic 7: Random goats eating the flowers off of the jeep that was parked near us. Animals roam everywhere here even in the middle of the city.

Exciting Weekend in Pondi

This weekend we went to Puducherry (Pondicherry) with all of our UTHSCSA group (3 met up with us after exploring another city) and 3 other students (2 from Australia and another from the states). We had prearranged for a driver for the weekend earlier in the week. It is much safer and less hassle plus it ends up being only around $15-20. Any way of course our driver shows up late and our "spacious" vehicle ends up being only a little bigger than a CRV that is supposed to hold 8 of us and all of our luggage. Needless to say we made it work. Three of us were in the back with these fold down seats. We headed out on our 4-5hr journey. While still in the city limits we pull over on the side of the road and the driver starts talking to Vasi (our Australian friend who speaks Tamil, the language spoken here). Apparently he did not believe that we requested an a/c vehicle (all 3 girls there said that they had made sure to request a/c) and he doesn't want to run the a/c unless we pay him more. Even speaking the language she has no luck and after speaking with the manager she still has no luck. We had two options go home or pay more (driving 4-5hrs with no a/c here is not an option, well at least not for us spoiled westerners). We gave in and paid more and so he continued on.

The ride was beautiful but rough. The scenery was so green and tropical. Closer to Vellore there were all of these massive rock formations that would jut out amidst the greenery it was quite spectacular. We also passed quite a few rice patties where the were groups of women working; all in their saris. The rough part was the roads were paved but not the greatest with frequent pot-holes and speed-bumps in the villages. Kathryn, Erica and I were in the back which meant that our head were in close proximity to the roof. Our heads became very familiar with the feel of the roof by the end of the ride, especially Kathryn's. In addition, all drivers in India are crazy as I've described before and our driver was not very smooth as he swerved and slammed on his breaks.

When we called during the week to book a hotel all of the places said that they were booked. In talking to other students who had been before they all said it would be no big deal. So rolling in to Pondicherry, at what was probably close to 9pm, all we had the name of a guy who worked at a hotel (that we didn't know the location of, only the name) who was a contact some other students had used when they came. Luckily we found the hotel and the manager was very nice and since they were booked he called all around to other hotels to help us find a room. No luck. He recommended a place called French Guest House where he thought there might be rooms. We roll in to the heart of Pondicherry. It is a pretty crowed place with bright lights every where. We finally find the"French Guest House" and it looks pretty sketchy but we go ahead and send the Indian/Indian looking girls inside to check things out. They think the place look decent enough and it's 2000 rupees (exchange rate is like 38rs to the dollar) total a night for 2 rooms each with their own bathroom and a/c. Each room was actually 2 separate rooms with a double bed in each. It was "perfect". We headed out for dinner. We were very excited about food without Masala and having some wine. The food ended up alright but in the whole restaurant there were only 3 glasses of white wine left and 1 bottle of red. Oh well, we still managed to have a great girls night out!

The next day woke up without much sleep as the beds weren't the most comfy and our bed didn't have a top sheet and so I was so cold. I even had my hoddie on with the hod up and I tried to roll up in the sheet bc I was a little afraid to sleep on the matress under the sheet. Breakfast was awesome! There was a french bakery and I had an awesome doughnut and then got a chocolate croissant for lunch! After breakfast we went shopping. It was kind of funny because unlike Vellore, Pondicherry has quite a few western visitors, most of them very hippie looking Europeans. Walking around with Kathryn with our blond hair and blue eyes we actually looked like we fit it, kinda. I bought a very hippie looking skirt which I later changed into that made me fit in even more :) We also walked around some of the French quarter which was very pretty and strolled down the coastline. There really is not much beach where we were. I think that much of it was wiped out by the tsunami. It was still really nice to see the ocean and it was so blue.

On Sunday we visited Auroville which is a community outside of Podicherry that was created to be a utopian society. Here is the quote from the website to give you a better idea: "Auroville wants to be a universal town where men and women of all countries are able to live in peace and progressive harmony above all creeds, all politics and all nationalities. The purpose of Auroville is to realise human unity." It has been around since 1968 with currently around 2000 residents from around 35 different nations. There is also this huge golden globe structure in the center which is quite impressive. In the center of the globe there is a room for meditation. They also do quite a bit of sustainable living research there. It is quite an intriguing place.

After all the excitement we made it home exhausted and in need of a good shower ;)

Fabulous Teacher

I appologise in advance for those of you who just don't want to read about more OB-GYN stuff. Don't worry I am going to do something else next week. I also wanted to mention that I added some pictures to previous entries if you want to check those out (one the first part of our group with Aruna's family, another of Ghandi street that I couldn't figure out how to turn, a picture of this cow in sitting on the side of the road (a common sight) with an autorickshaw about to pass it, and at the bottom is a picture the courtyard in front of the church at the school). In this entry I have included a picture of the main enterance to the hospital.

Didn't get a chance to write yesterday. We had a full day. I started it off by going to OG OPD (Ob-GYN out-patient clinic). I got to work with the chief "consultant" (that's what the attendings are called here) who was one of the greatest teachers. Despite being very busy, I think that he said he normally sees 40 patients in one day (plus all of the patients the residents have questions about), he always talked to me about each patient and some times would even translate for me when the patients didn't speak English! Each state has it's own language so there are a ton of different languages and dialects spoken in the country and even Hindi is not spoken by a majority of people in India. Often times English is spoken bc it is more widespread as it is taught in school.

Clinic doesn't quite work the same way that it does in the US. The patient shows up with their chart and brings it into the doctor. They don't just bring it in while the doctor is in between patients they just bring it in whenever they feel like it. Right in the middle of talking to another patient...no problem. Not only that but if they have a question they forgot to ask or just want to know how much longer it's going to be they just walk right in! It's not just the patients either. When the residents have a question about one of their patients they walk in, wait for the "consultant" to pause and then in front of the other patient tells the consultant about their patient! It was very different. I don't think that HIPPA would appreciate that :)

We saw quite a few OB patients throughout the day. I was very embarrassed bc even though I want to do OB we are so bad back home about relying on a dopplar and ultra sound that out OB physical exam skills are quite poor. Dr. Abraham (I couldn't say his last name) was great about helping me to feel the position of the baby and talking about how to describe the what I felt. I know that it may sound basic but we never do that back home and so I learned it but it had never really stuck. I think another important factor was that most of the women we saw were not obese and so you could actually feeling the back versus in San Antonio where it's some time even hard to feel the top of the uterus.

In addition to seeing the OB patients we saw a quite a few GYN issues, many of the same that we see at home. So the table that the he used for exams was literally a table with two extra pieces of wood at the end for the women to put her feet on and a very think pad on top, no stirrups. There were quite a few women who needed pap smears, which they don't start doing until at least after the age of 25, and what do they use to collect their sample...a tongue depressor! It was crazy.

Another neat experience getting what how Dr. Abraham taught the medical students. Midway through the morning four medical students showed up. Dr. Abraham was also wonderful about including them into the discussions about the patients. I wished that more of the doctors that I had worked with 3rd year would have been like him. It was all fun and games though he would ask them question and expected them to know the answers. When they didn't he gave them a lecture on how to remember lists of causes of medical conditions. All of this was done in a very respectful way. They students were very smart. I don't think I knew near as much as when I was in their position.

It was a really great learning opportunity but very draining. It's hard being at the end of medical school and just shadowing a doctor all day. I was very greatful though that he was so willing and excited to teach. I found Seema, Jenn, and Kathryn shopping on Ghandi so we ran a few errands and then stopped by a glasses store on the way home. We had a blast trying on different frames. It is like $30 for a new pair of glasses with lenses!!! For dinner we met up with some of the students who are working at the leprosy hospital at a nice hotel in town. Even at a nice hotel dinner is still under $5. After dinner we went up to the rooftop and had a beer. Despite not being very good it was nice.

Today I tried to go with my OG team to the OT (operating theater/room). After standing around waiting in the room for quiet a while right before they were about to drape and prep the patient I got pulled out by the nurse... Apparently the patient was HIV+ and so even though I wasn't scrubbing in I was not able to even be in the room. :( I spent the rest of the time in the labor room after that. It still freaks me out when they cut their huge episiotomies. We were watching one ladies delivery and this woman was tough. No pain meds and then they closed the lacerations that she had and neither Bimpe or I saw them give any local anethesia! There are those though that just can't take the pain (not like I would be able to) and she just would not keep her legs open during the delivery. When the baby actually came out I think that the women had her legs almost together.

Tomorrow more OG and they we are heading out for Pondicherry (Puducherry) which is an old French colony on the coast about 4hrs away.

Covered in sweat and DEET,
Nicolette

OGee that hurts

Briefly bc showering is a daily must here and I still haven't had one today... Today was my first day of OG (or OB in the US). I worked in the labor room with Erica (I was told I referred to her as Eric in a previous posting, sorry Erica) and Aruna all day. So in order to be in the labor room you have to wear scrubs...their scrubs. They are really short and huge, I mean massive. I would love to see Stephanie in a pair. Right when I got there they said there was a c-section going back so we all decided to go observe. The shoe covers they make you wear are awesome they are fabric with rubber coated soles. The senior resident and the intern (here everyone does an intern year before you even apply for residency) did the c-section. It was pretty much like sections at home only they go really quick even though it wasn't emergent and there really is no using the bovie, which is okay bc they aren't that annal about making sure the uterine incision is completely dry before closing the fascia. I was also totally considering going to see some CT (heart) surgery but oh my gosh it is so freaking hot in the OR. I would totally pass out if I had to stay in there for an entire bypass.

After our section we went back to hang out with the interns in the labor room. I forgot to mention that the labor room is one huge room with curtains that separate the beds for exams and the delivery. No male family members are allowed back there. It was amazing to watch in the women who were laboring. In the states or at least at UH (the hospital we work at in SA) it seems like every woman, unless it's child #3+ gets an epidural. Here there is no such thing for the average patient and no other pain meds for that matter and they cry way less than then women who have epidurals back home. Not only that but when they push these women push. There is no messing around, they get those babies out. On top of that they don't hesitate to cut an episiotomy and a BIG mediolateral one at that. Erica and I were watching one lady and so in awe of how well she was pushing and progressing. Everything was going well but I guess not fast enough for the nurses who were delivering her bc they didn't think twice before getting out the scissors. Erica and I sat in the back just hoping they let her get one more good push in bc it seemed like that was all she needed but for we knew it she had a nice big cut. They give them some local pain meds for that part and some thing orally after but is still amazing. I don't know what a women back home would do if you told her she had to deliver in a room with 20 other laboring women with no pain medication...wow!

A few of us had brought suitcases/boxes of clothes (given by our friends back home) to donate when we got here. This evening we went to drop them off. Though a connection at one of the hotels brought them to the "school for blind children". It is a school and home (for some) blind and physically disabled children. They were all so cute and excited about what we brought. So thank you to those for you who brought us clothes. It was really a rewarding experience and definitely made me miss the children I knew in Russia.

Well, that was much longer than I hoped and I really have to go so I am not going to read over what I wrote...sorry.

-Nicolette

Shopping Spree

So last night we had a fabulous dinner at the Darling Hotel (their hotel names make me laugh). We sat on the roof top terrace which had a great view and there was a really nice breeze (I even got chilly), I totally forgot were I was. After dinner I took my first shower in the hostel...the water pressure sucks and the stream of water is pretty pathetic (not to complain bc at least there is a shower head and the water is hot!). I then tired to dry my hair (in attempt to make my hair manageable in the most amazing humidity here) and I definitely made the power go off in the bathroom right before Aruna was about to step into the shower. Luckily we only had to flip the circuit breaker and it came back on. I waited until she was done to finish.

Had a great night sleep, with a little pharmaceutical help, and woke up unsure of where I was. The dorms remind me of the Russian dorm rooms I used to stay in so I was still confused until I looked over and saw Aurna in the other bed. Breakfast again at the canteen. It was pretty good. I needed a break from the masala (the spice they use) so I had toast (it comes as two pieces w/ butter and jam in btw, no other way), an omelet, and tea. The tea here it great. They make it super hot with lots of milk and sugar. In oder to cool it they give it to you in two containers and you pour it back and forth to cool it. I think it is way better than waiting for it too cool plus it cools more evenly.

At breakfast we met out classmate, Kathryn who was here last rotation, and she showed us everything we had to do to register. We had to register at the school and then go into town to the hospital to pay our fee. While we were there we met the new director of "office of development" and two other Americans who were there to help open the office. The office is to help with the student experience but also help raise support and awareness about the hospital. We watched this 10min DVD about the hospital. I really almost cried. I don't think I realized how big and important this hospital is to this area. Their goal is to be able to provide medical care for the neediest of India but they understand that in order to provide the best care they have to have money. So what they do is try to make the hospital the best it can be to bring in paying patients from all over the country and then they are able to make a profit to cover the expenses of those who can't pay. For this area it really is an advanced hospital despite the lack of commodities that we would expect in the US (ie a/c, nice rooms...) and the school is very respected around the country for their quality training of medical and nursing students. Also, the dedication of the physicians and nurse not only the people in the city but to the people in the surrounding villages that they physically go out to their villages to visit is astounding. It really made me realize what a great privilege it is to be here and to get to work with the staff here.

Moving on to something way more deep and insightful...shopping...hahaha. In order to work properly you have to dress properly. So we headed down to Ghandi street to purchase some appropriate Indian attire. It was so much fun. It was funny bc all of the outfits that I liked looked like the patterns of my bedspread. We were very successful and will definitely fit in..hmmm. So when you buy the outfits a lot of the time they show the tops with no sleeves and I couldn't figure out why bc it is totally inappropriate to wear sleeveless tops here. Kathryn had to point out the extra fabric that was included with the package and told me that you have to get them sewn in. I'm still not sure I understand why they do it that way. In addition, the pants are one size fits all. Therefore, you have to have a drawstring which you also have to get that put in. So I still don't have a complete Indian outfit bc they are at the tailors. You all will have to wait for a pic of me in my Indian outfits. I know that is something that all of you are very eagerly awaiting :)

The rest of our group arrived today. In total there are now 8 of us here from San Antonio. Tonight we have an international student gathering which will be fun bc there are quite a few students rotating here from many different countries. Tomorrow I will start on OG (that is what they call OB-GYN here, which is actually much easier to say and then you don't get the confusion of how to pronounce gyn) and so I will actually have to go be a medical student again :)

Off to dinner covered in a nice layer of sweat and dust.
Nicolette :)

Made It!

We finally found good internet. I think I would have died if I had to use dial-up and write daily in a blog. So here's a brief summary of the past few days...(warning, did not edit or check spelling)

Thursday: In traditional Nicolette fashion I managed to leave all my packing to the night before I left. I don't think I could do it any other way. I still managed to get everything done. Left San Antonio a little later than planned by way of the wonderful rental car that was automatic but not. There was no clutch but I still had to sift gears which meant that I actally had to pay attention while driving in trafic. I'm sure many of you are very glad you weren't riding with me. I met Aurna and her Dad at IAH and then began out in total 20hr or so trip to Chennai.

Friday: Still flying. I finally managed to sleep on the second leg. I think only out of sheer exaustion since I hadn't really slept that much prior to leaving.

Saturday: We arrived in Chennai at 1am. As soon as you walked off the plane you could feel the humidity. It was awesome. I was very happy to be with Aurna and her Dad as they showed me where to go and what to do. All of my luggage made it, even my massive bag which was over the wt limit. Since I do everything last minute I was unable to get a room at the hotel Aurna and her Dad were staying at online. Since I wanted to make sure that I had a place to stay, with the help of Mary, I found a place that looked decent, Hotel Shelter. There was an extra room at Aurna's hotel but I thought they had already charged my card and so I opted to stay at the Hotel Shelter. Aruna's Dad helped me get a pre-paided taxi and then I went on my way.
It was interesting how much Chennai reminded me of Kenya. I got a little sentimental about my trip to Kenya two years ago and I realized how much I've missed traveling these passed two years. I'm not sure I can explain the feeling I get when I go overseas but I get the same feeling every time. The place maybe vastly different than any other place I've been before but a find a sense of familiarity.
Any way, I arrived at Hotel Shelter in the middle of some historic part of town. Of course they didn't have my reservation, which I figured would be the case, and kicked myself for not just staying at Aruna's hotel. I got to my room and it was definitely a native hotel. For some reason I was expecting something western, not sure why. It did have a realy toilet that I was greatful but after being on a plane for the past two days I was really looking forward to bathing. The shower was just another side of the bathroom with a "shower head" and that was it. The bedding was definitely a little more than suspect and so I opted to put one of their towels at the head of the bed and then got my pillow and only used the sheet to cover my legs. The phone in my room didn't work so when Aurna tried to call the receptionist guy had to come up and deliver me my message. So I was so excited to finally put my head down on a pillow but was nervous about not waking up becuase I didn't bring a travel alarm (or any way to tell time for that matter) and there was no clock in the room.
The second time I woke up it was light out so I called down to the lobby to find the time, 7:30. Went down for breakfast and had an omet and chippati. Then finally got my shower which was like a sanding under a garden hose, but I couldn't complain and the water did get warm at the end.
Aurna and her family (Dad, aunt, and uncle) came and picked me up with Eric and Bimpe and we headed out to Vellore which is 70km west of Chennai. We had lunch on the way and was reaquained with the squatting toilets!. I'm not sure about this loosing weight when you go to India. Although my stomache doesn't appreciate the food I think it's great. It took about 3hrs to get to Vellore. I was a pretty drive; lots of palm trees. Once again it really felt a lot like Kenya. We dropped Eric and Bimpe off at their hotel which is near the hospital and then went to find our hostel at the CMC (Christian Medical College) campus which was an extreamly complicated task. I lost count of how many times we had to stop and ask for directions to the hostel even when on the campus. I was reminded that in order to not be overwhelmed with frustration while in a forgein country you have to have to be very patient and really just go with the flow.
We met some of the other students staying in the hostel. There was a guy from Sweeden and two girls from Australia. Our room was a basic dorm like room, no a/c but there is a fan, a decent shower, and a western toilet and it's only $2/day. You can't beat that. So we went back in the city for dinner with everyone at the hotel and then took an autorickshaw (3 wheel motor bike thing with a bench seat in the back) back to the hostel with Aurna's dad and uncle. Of course when we got to the campus we couldn't find the hostel and it took a while to find someone who could point us in the right direction.


Sunday: Despite the no a/c and the amazing humidity it was actually not uncomfortable sleeping. We did have the fan on celling fan on as high as it could go and it works really great. There is a canteen right next door that we went to for breakfast. We had dosai (a huge crepe like thing that you dip in this kinda spice sause stuff or chutney) and tea (in india this means with a ton of milk and sugar that you pour back and forth b/w two containers to cool off before you drink it) all for less than 50 cents. We then took an autorickshaw back to the hotel and got Erica and Bimpe and went on a search for Indian clothes. There wasn't much open so we abandoned our search empty handed and decided to wait till monday. We did however accomplish our major goal of walking around the city and not getting hit by all the crazy drivers. There really are no such thing as sidewalks here and there really aren't lanes so much that people drive in. In addition, the don't wait for each other so cars/rickshaws are alway passing around each other and driver not pedestrians have the right of way.
Well for now that's all I can write right now. I've been typing way too long.