What's up Jaipur!?

Sorry for the lull in posts, we’ve been on the road and in between spotty internet connections. Thursday morning proved insightful as we got the chance to sit down with Dr. Kokani at the Pune District Hospital for the second time. We gleaned information regarding potential users and stakeholder perspectives. One of the main takeaways was the complications of device implementation within a hierarchical health care systems such as that of India. Our understanding will drive design decisions and business strategies come fall semester.

After the morning meeting we headed to Pune Airport. Sorry, nothing too blog worthy here… we waited for 3 hours, watched Josh take down a box of mango pulp candy called Albomurphy (sp?), played a game of chess, boarded a plane on the tarmac, took off and an hour later we were in Jaipur. Unfortunately we forgot to take a final picture with our driver Artourage, so this action shot will have to suffice (chances are he’s honking the horn at this exact moment).

 

Jaipur is the capital city of the northwestern Indian state called Rajasthan and a place of immense history. Today we woke up early to tour Amber palace (the ‘b’ is silent) and City Palace. Amber palace was built in the 16^th century and took 137 years to construct. The royal family has since moved their permanent residence to City Palace. Our tour guide at Amber palace was great and we got the chance to play the instruments for the entire Palace! We also got coaxed into visiting the shops associated with the grounds. Not a second went by in which someone was not trying to sell us something. Finally, we drove by the Water Palace, which was the summer home of the royal family, not too bad! The lake served as a natural AC.

 

  

There were elephants, camels, and snake charmers populating the grounds!

      

Following our Palace explorations, we embarked on the 7 hour, 180 mile drive  urban safari from Jaipur to Bikaner. The roads were in stellar condition!! We will be staying in Bikaner until the 21st.

 Friday morning we went to a medical college in Bikaner. We had the chance to interact with community health workers, physicians, and patients in a rural setting. The internet is in and out right now so details will have to be saved for another post.

Maharashta at its Finest

For the past two days, we have been touring medical facilities at the district and sub-district level outside of Pune. Yesterday, we went to a primary health center (PHC) in Manchar called Tal-Ambegaon. The superintendent who runs the center gave us some helpful advice about the scope and target market of the Hemoglobe project. We got a tour of the lab, the clinic, and the maternity ward. While we were walking around, we saw their training lab, which was stocked with Laerdal's Neo Natale and Momma Natalie kits! We even got to talk to a mother with a newborn about her experiences there. She was timid at first, but with Pushkar's help, before long she was chatting and smiling with us.

 

Afterwards, we decided that we couldn't go to India without seeing a Bollywood movie. Chennai Express was recommended by many of the locals, so we set out for the local theater! It turned out that the movie was all in hindi, but we were still able to follow along-at least most of the time. The singing and dancing were fun to watch, and the movie itself was ridiculous in typical Bollywood style!

Today, we went to two health centers with a regional director of Pune. These two were model centers, and have been used as examples for the rest of India. First, we sent to a sub-district center, which is the first point of contact for pregnant women in rural areas. There, we spoke with some community health workers about their work at the clinic, and with a first-time mother who was nervously awaiting her delivery

On the way to the next clinic, we stopped at what is believed to be the site of one of the Hindu god Ganesha's incarnations. There we saw a temple to Ganesha inside of a walled courtyard. Sorry, no pictures allowed!

Finally, we made it to the Lonikalebor PNC. Once again, we got a tour of the facility and spoke with the lab techs about their methods. Then, we got some conversation time with the ASHAs, who go from house to house to provide health information to mothers, and who were the original target audience of our project.

Since it was our last night in Pune, we decided to check out the nightlife. We took a rickshaw to a nearby club, and if we thought driving through the streets of Pune was scary in a van, it had nothing on the riskshaw. We found what was supposed to be a really nice club, but unfortunately it was salsa night. Much to our surprise, Indians are fantastic salsa dancers! Not wanting to draw more attention to ourselves than we normally do here, we left to find a more comfortable setting. We ended up trying our hand at a karaoke night, but it turns out that Destiny's Child was a bit too much for us to handle. 

Finding Harmony in Chaos

The last 48 hours in Pune have been some of the most eventful and enthralling of our lives! It is hard to even start this entry, so we decided we would make a top 10 CBID-India-Jhpiego list of moments to summarize our immersion thus far.

10) Nightlife
We wanted to experience the night life of India so, after some debate, we headed to the loudest sounding place we could find, which happened to be a rooftop patio bar/club called WTF! on Saturday night. Unfortunately for us, the closing time was 11:30 and we were not allowed in. We did split a total of two delicious beers, from a new company called Indus Pride (same makers as Miller).

9) Cricket, soccer and basketball
Yesterday, when we walked through the town we took a detour through the campus of Ferguson College, a well-known college in Pune. There, we watched local youth playing low quality basketball, medium quality soccer and high quality cricket. The campus was very nice and its dirt-laden fields were quite charming in their own way.

8) Hike on ARAI Hill
Tonight, our awesome host Pushkar took us hiking on a small hill in the middle of Pune. Even though it was in the middle of the city, we would never have found it had it not been for our host's experience. We saw some cricket being played, some Hindu worship sites and even had a beautiful view of the city. It is also great to talk to Pushkar, who has an extremely interesting background and is very knowledgeable about all aspects of design.

 


7) Running of the Buffaloes
The group had our first experience with buffalos during the hike today. As we parked our car, we saw the glorious, horned animals running around. It didn't seem as if their herder had any control over them whatsoever. Josh was acting brave for the photo, but he was scared.

6) Jhpiego-Laerdal connection
One reason for our awesome experience in India thus far is the guidance we have received from Jhpiego and Laerdal. Dr. Rashmi, who works for Jhpiego, has been instrumental in setting up our hospital visits and introducing us to the right people. Pushkar, a Laerdal fellow, has an excellent understanding of our project and has all been helping translate our questions every step of the way. Not to mention he is an excellent tour guide and no one knows more about Pune than he does.

5) Celebrity Moment

The three of us felt famous when a couple stopped us on our walk and asked to take several pictures with us. Kevin wanted one of his own and we have displayed it below. Later on the same walk when we entered a park, we were followed by a group of 5 kids led by a young fellow wearing vibrant blue pants named Arif. While he was the only one of the group that had the courage to talk to us, we really enjoyed the attention.




4) Crazy Driving
As we have said many times, words cannot describe how crazy the driving here is. So here are a few video clips to put it into perspective.

3) Bargaining
The team also had our first ever experience with bargaining over the last few days. Josh spearheaded the process by bargaining for two handmade wooden heads of gods. While he managed to drop the price down from 450 rupees for one to 600 for two, it is pretty likely he still got fleeced. Then again, a $10 American for nice crafts is not a bad deal. Ashley and Kevin made more purchases of their own for  very modest prices, but still tried to bargain for the sake of it. It must be said that bargaining is an art form that can be very rewarding to practice.

Josh's wooden heads.

2) An excellent visit to Pune District Hospital
The team had a highly enlightening visit to Aundh District Hospital in Pune on Saturday. There, through our connections, we were able to meet with the civil surgeon for the whole city of Pune. While it took a while for him to warm up to us, the interview techniques we have developed eventually allowed us to glean some very useful information from him. We also met two gynecologists who were very knowledgeable about ANC screening and diagnosis in general as well as the whole process. We were also able to get a glimpse of the process that takes place at the district hospital and Ashley even had the opportunity to see a complete examination of a pregnant mother. Then, we followed one of the hospital administrators into the rooms containing the hospital diagnostic equipment. This equipment included a complete blood analyzer (cell counter), a machine to test for HIV and the Sahli's test, which is used for anemia screening. Finally, we had a tour of the maternity wards with one of the gynecologists. It was an excellent experience and hopefully the level of pertinent information we received was a sign of things to come for the rest of the visit.

HIV testing equipment

Aundh Hospital, Pune, India

Sahli's Test for Anemia

1) Culinary Experience
The team could probably go on for hours about how much we have enjoyed the food we have had in India so far. To add to this, it is quite miraculous that none of us have gotten sick. The hotel breakfast has been excellent, with a wide variety of juices and rice-based Indian cuisine. Pushkar has taken us to some excellent restaurants, including a South Indian one where Kevin and Josh got the 5 course platter depicted below. At a cost of $1.50, we could probably say that it was a good bargain. We also went to a street restaurant owned by a locally famous chef and tried a wide variety of food including the delicious and spicy panipuri for 30 cents. It was an incredible meal. At lunch today, each of us enjoyed a ginger kiwi lassi, which did not disappoint!

Your local KFC

Tomorrow, we are planning to visit a sub-district hospital and we will potentially be seeing a Bollywood movie at night. We can't wait for either!

Gaining confidence in India

Just wrapped up day 1. Here's an update on the last 24 hours:

Upon arrival in Mumbai (home to 18.4 million natives), our first task was to get our luggage. This turned out to be more than just your average baggage claim. Everyone stood 4" from the track so spotting and grabbing our bags was difficult. The crowd started to disperse bag by bag and we got moving an hour and half later. The three of us then checked out through customs and exchanged dollars for rupees. At an exchange rate of ~1:60, the dollar goes along way here. We had our first tourist moment just before we breached the airport doors at the prepaid taxi stand. We told the clerk the name of our hotel, paid 280 rupees, and headed for the door. After realizing we (okay mainly me) forgot to grab the prepaid slip we had to go back. Unfortunately we we're already beyond security so attempting to go inside caused a mini scene. After finally figuring out the slip, we passed through the gate and all craziness broke loose. On our way to the cab, about 5 guys rushed to take our bags then hassled us for a tip to which we responded by forgetting Pratik's advice (do everything yourself) and tipped. The bags were then strapped on to the top of the car with a rope and we hit the road. 

Mario Andretti couldn't have been prepared for this drive. There really are no lights, no lanes and no visible organization. Red lights seem to be a suggestion and horns are used to warn others of your position. Thankfully our driver was a seasoned vet. We swerved, dipped, and bobbed our way to the hotel. 

Today was better after getting over the initial shock of being here. We woke at 6am and drove 4.5 hours from Mumbai to Pune. The natural scenery was beautiful. We saw monkeys, palm trees, and waterfalls in Lonavala. The area's waterfalls during the rainy season supply Mumbai with drinking water for the year. 

We immediately met with Dr. Rashmi (Jhpiego), Pushkar (Laerdal GH), Dr. Kokani (Region's Maternal Health Director), and the Region's Child Health Director at the Reproduction & Child Health Center in Pune. The impromptu meeting was extremely informative. We got to ask questions regarding health initiatives in the region and quickly learned that anemia was not only on the radar, but ranked high among antenatal (AN) concerns. Low birth weight, anemia, and malnutrition rounded out the top 3. We have a chance to meet with this group again on Wednesday after experiencing the clinics first hand; their insight has been extremely valuable. 

The team members are also wonderful hosts. Lunch was a five course Indian meal consisting of tomato soup, vegetable 'meat' balls, naan and dips, tikka masala, and ice cream cake. Amazingly this whole meal cost only $5 per person! Dr. Rashmi is guiding us tomorrow through a primary health center where we'll be interacting with community health workers and nurses. Our Jhpiego/ Laerdal team is great and the last 24 hours have us all feeling much more confident about being in India!

Ha det Norge! (Goodbye Norway!)

Sadly, our time in Stavanger is winding down. This morning concluded our sessions with Laerdal as we presented our plans for the trip and received some final comments and pointers for our interviews in India. We got some excellent tips, and hope that we can use those to our advantage as we try and get our bearings in Mumbai and Pune.

Then, after another fantastic meal, we got a tour of Laerdal's simulation training center, SAFER, by Tore Laerdal himself. In these facilities, nurses, hospital workers, firefighters, and EMTs all come and train on Laerdal's simulation mannequins for all sorts of medical emergencies. They have a gutted ambulance, mock hospital rooms, and even a small apartment in the building to make sure simulations are realistic!

We then received a compression-only CPR training course developed by Laerdal on the mini-Anne, one of their simple training mannequins, and then on more conventional mannequins. Josh proceeded to save a dummy "Aaron," another Hemoglobe team member, from cardiac arrest!








After a final meal in Sunny's favorite Norwegian Cafe and a walk in a sea-side park, we said goodbye to Norway and began to pack for India!

Thanks again to all of the Laerdal staff for their generosity and hospitality this week!

Made it to India!

Writing this from our hotel in Mumbai, ride from the airport was memorable. Computer's about to die (and Josh apparently bought the 'Global minus India' converter pack) so that's it for now. Plenty more updates to come...

Visits to Laerdal and More Glimpses of Stavanger's Beauty

The last couple of days have been extremely educational and fun- both in Laerdal's headquarters at SAFER and in our travels around the beautiful Stavanger. We woke up early to catch the sunrise! Here's Jan, a statue, Matt, and Jenny catching some early morning rays.

 During the working hours of the last two days, the CBID team was given tours around Laerdal's state-of-the-art facility and received lectures on various topics related to the day-to-day functions of the company. We learned more about the company's philosophy on innovation, which is measured entirely by the value delivered to the end user. We also saw some of the exciting technology that the company is working on such as the SimMan 3D, a CPR simulation doll that is able to sweat, cry, dilate its pupils in response to light and do pushups (the last one is a joke). 

     

While we were not able to take pictures of the manufacturing facilities, here are some pictures of Barrett and Pratik giving birth during one of the courses. Mama Natalie, one of Laerdal's simulation tools, is the being used to simulate a live birth. This is the same product that is being distributed across the globe to improve OB care. I must say they made great mothers!

And here's Jenny and Pankti doing their best to save a baby's life in the Helping Babies Breathe (HBB) simulation. HBB is a multi-partner program designed to improve resuscitation care during the golden minute following child birth. 

At night, we went to the beautiful Utstein Abbey, an ancient monastery that now serves as a site for tourism. Utstein was built in 1263 (that's not a typo) and housed up to 12 monks. There we had a guided tour and were even treated to a private concert with the added bonus of special acoustics from the old church.
















Tonight, we went on an epic 5 hour hike on the famous Pulpit rock after we parked our bus on a boat. We were motivated to get to the top, where the views are said to be spectacular. Unfortunately the hike was not injury-free. We nearly lost Josh to phantom appendicitis (symptoms include swelling pinkie right pinkie finger), but luckily everyone lived to tell the tale of reaching the summit. From the summit, the view was unfortunately foggy. In any case, the Laerdal-CBID crew really bonded over the 300 meter ascent.  Kevin, in particular, seemed very excited to be there.

  

Tomorrow, another day of presentations and training sessions awaits us at Laerdal. We will also have a chance to update Laerdal on the status of our projects and what we plan to accomplish in our 2.5 week field immersions. I'm sure we'll get a lot of helpful feedback. Unfortunately we'll also have to say goodbye and good luck to the Kenya and India-Medtronic teams who will be on their way to their respective countries.