Bangalore, India - St. John's Medical College

Kevin Cavanaugh, Spring 2010

Before departure

I will not cover the details of the paperwork to be submitted to St. John's in this essay as previous essay writers have discussed the necessary paperwork in detail. I will mention that it is very likely you will not receive confirmation of the receipt of paperwork from St. John's before your departure for India. Don't fret, when you get there and meet with Jacintha everything will be arranged appropriately. I do suggest, though, that you keep a copy of a receipt of any monies sent to the college. I used a certified money order to pay for my tuition and this worked well. You will not need to pay for accommodation until you arrive at Annex III.

What to bring (the essentials)

• Bug spray (lots of it, with a high concentration of deet)
• Towel
• Laundry detergent
• Stain stick (my clothes are spotted with yellow curry)
• Sheets
• Sunscreen
• Purell
• Wet wipes
• Clothes you don't like or don't mind throwing away when you're done
• Sandals
• A converter (although this can be bought in India for a cheaper price)
• Water filter (not essential, but handy, and will probably bring peace of mind in certain situations)

Internet and phone

I brought my laptop, and, it was nice to have, but definitely not necessary unless you plan on staying for longer than one month. If this is the case you can buy (~2000 rupees + 800/month service fee) a small modem (that looks like a jump-drive) from Reliance (multiple stores throughout Bangalore, run by the government) that plugs into your computer. I used my laptop to watch movies and download podcasts. I mainly used the intranet café run by Reliance at the Forum mall (I will cover directions to the mall later in the essay). The intranet here was reliable, fast (relative to other places), and cheap (15 hours for 800 rupees). You can also use the intranet at the campus computer lab (directions later in the essay; the lab opens at 09:00). Be forewarned, however, the lab is cheap, but slow and unreliable. It's best to go there during off-peak hours (avoid it from 4:00 – 6:00).

I did not get a phone. At times this was frustrating because it led to more coordination to meet friends etc., but in the end it worked out just fine. The process of getting a phone is somewhat of a hassle. When you meet with Jacintha ask her to write you a letter that confirms your address in India. When you go to buy the phone you will have to present this letter with your passport and possibly your badge from St. John's. Most foreign students went to Virgin mobile and several had complaints about either the service or the actual phones.

Directions to St. Johns

From the airport take a Mehru taxi to St. John's. Mehru will give you a set price (around 600-700 rupees) that is fair. As soon as you exit the doors of the airport you will be accosted by several people offering taxi services – DO NOT take a ride from them as they will charge you 2-3 times what you should pay. The Mehru line will be marked and there will be a designated (and official looking) worker at the head of the line. When you get a cab tell them to take you to the Koramungala BDA complex. The gate/entrance of St. John's that is closest to Annex III is directly across the street from the BDA. When you go through the gate you will see a large building in front of you, this is the auditorium). Proceed to the right and continue until the road ends at Annex III (not even one city block).

Finding Jacintha, the computer lab, and the mall

When you exit Annex III proceed straight and take the first right after the auditorium. Soon you will see the therapy animals (seriously). At the corner where the animals end take a left and proceed straight until you see a guard. At this point you can see the main path to the hospital on your R. Cattycorner/ diagonal in a rose colored building is the building where you will find Jacintha. Her office is the first on the right and opens at 09:00. She will ask you to go get stamp-sized photos taken for the ID badge. You can get these taken at the BDA for 60 rupees. To find the shop go to the main staircase of the BDA and take a right. When you see a sign for the flower store, proceed through the tunnel/alcove on the left, the shop is the first one on your right.

To get to the computer lab continue down the same path you took to Jacintha's and take a right when you see the guy selling coffee. Proceed straight to the back of the building and the computer lab is tucked away here.

To get to the forum mall it's easiest to exit the main gate of St. John's and take a right. Continue straight until you get to the gas station and veer to the right. You'll walk for another five minutes or so until you will see the mall across the street.

Rotations at St John's

You can elect to do pretty much whatever you want while at St. John's. They are very informal and flexible with foreign medical students. I did one week of general internal medicine / infectious disease, two weeks of dermatology, and one week of community health.

A word about what to expect while at St. John's: ward rounds are extremely busy (patient volumes 2-3 times what we have in the U.S.) and conducted in Kanada (a dialect spoken in southern India). Unless you ask a question or two the attending/residents will assume you are not interested and you will fade into the background. I would suggest asking a couple of thoughtful questions toward the beginning of rounds. Once you do this, they are generally very gracious and will do the best they can to explain as much as possible (time permitting). Given the language constraints, attendings and residents do not expect you to work at the same level as you would at home. Responsibility is minimal to none and you can basically just observe.

In internal medicine I worked with Dr. Ravindran and he was very knowledgeable and nice. The residents and interns are great sources of information. The outpatient internal medicine was extremely interesting and there was a little more time for explanation and education. Dr. Ravindran has an interest in HIV/AIDS, so if you're interested in these areas he is a great resource and you will see a lot of Tb and HIV.

Dermatology was a great experience. I worked with Dr. Shubha in the outpatient procedures area for one week, and with Dr. Fiona in general outpatient practice. I would highly recommend working with both of these physicians. They were extremely nice and took the time to explain everything that walked through the door. Cases were interesting and included the following: pemphigus vulgaris, bullous pemphigoid, leprosy, lichen sclerosis, dermatitis herpeteformis, vitiligo, psoriasis (pustular, palmar-plantar, and large plaque), polymorphous light eruption, lichen planus pigmentosis, lichen simplex chronicus, pyogenic granuloma, dermatosis papulosa nigricans, acanthosis nigricans, molliscum, pityriasis alba, acne vulagris, pyoderma gangrenosum and many many others.

Community medicine is also a great experience and gives you a wonderful opportunity to see what medicine is like in a rural setting in India. Each day a team of docs/residents go out to a different village and set up camp for the day. Pathologies are interesting and the environment is a little less formal than the hospital, which makes asking questions/being part of the team a little less intimidating.

Other useful tidbits: Although they say you need to wear your white coat, you don't. It's really hot in Bangalore (especially in April), so wear lightweight clothing (linen and short sleeve shirts). You do not need to dress formally. Flip-flops are okay to wear for shoes.

Autorickshaws

The drivers of autorickshaws can be a point of frustration while staying in India. My only tip is to suggest you haggle until you get the metered rate. This can be difficult and you may have to try a few drivers, but it's really the only way to guarantee that you are paying a fair price.

If you have any other questions or concerns before leaving for St. John's please do not hesitate to contact me at kevin.cavanaugh@gmail.com

Best of luck and warm regards!