Saturday, June 7, 2008

Yusuf Meherally (Sunday, June 1)

We started our morning early as we gathered for the buses at 8 AM. We met Mr. Shah, director of Yusuf Meherally, for breakfast that specialized in dosas, sheera, and masala chai tea. The team members ate well to ensure our energy for the day. We hopped back onto the bus for a 45-minute ride to the Yusuf Meherally - Mumbai site. Mr. Shah explained to us about the healthcare that they provided. Medical doctors and healthcare professionals that work at various nearby hospitals, such as KEM and Saifee Hospital, would volunteer on the weekends to provide service for this underserved population. A variety of healthcare is provided at different times of the month for general surgery, dentistry, radiology, opthamology, etc. It appeared that facilities were clean and supplied well. They perform nearly 40 surgeries per weekend every weekend of the year depending on the type of specialist available that weekend. After a short tour of the medical village, we were lead to a large auditorium. A large community audience (>100 participants) gathered in this room for the Duke DPT presentation on "Protecting Your Back with Proper Biomechanics" in lifting and gardening. We had an age range of 12 - 90 year olds, with the majority of participants being teenagers. Although it was a challenge to teach, due a language barrier, a translator was available. Groups were broken up into smaller groups so we could assess proper biomechanics and provide practice in different situations. We felt that each person benefited and rewarding to see students utilizing proper technique with lifting of chairs during clean-up. After an 1.5 hours of presentation, Mr. Shah continued the tour of the Yusuf Meherally plantation. We took a walk in their organic gardens to see pineapple and mango trees, vegetables, gourds, okra, and various mint herbs. We also saw the supported work operations, like the bakery (mmmm, fresh bread and biscuits), soap makers, and pottery barn.

Yusuf Meherally was a great place to visit and the relationship we have now established will benefit our program greatly. We look forward to our continued work with them over the next few years, possibly even at their other sites across India.

"Off to Cancun (of India) - Goa"

So we were very excited to have a few days to relax in Goa, as we had been very busy with business meeting/dinner, developing presentations, and preparing for seminars. We had time to sleep-in, take time for breakfast and bring down our luggage for storage. We met Neeta and Romi, as they would be accompanying us to Goa, for ease of travel. They were very helpful in navigating us through the airport and communicating for the bus/hotel. Our flight ended up being delayed about 1/2 hour with additional waiting on the plane. We arrived at the airport at 5 PM and we had another 45 minutes to drive to the Nanutel Hotel in "Old Goa."

By the time we got to the hotel, we only had a few minutes to "freshen up" before going to Martin's Corner. It was a larger restaurant found away from the small city, in which many Indian celebrities eat and partake in the activities of this restaurant. For all we know, we could have been rubbing elbows with a few Bollywood stars! We had a great dinner and fortunately we were there for kareoke night. Every few song choices, our group would sing in unison songs like "It's My Life", "Take Me Home" and La Bamba. We had a few looks from the restaurant be we were thoroughly enjoying ourselves. Our meals were delicious. It was the first time we did not do "family-style" eating, so people were able to share and pick-and-choose their meals. Ordering seafood in Goa was a recommendation by many people we crossed paths with during our travels. The majority of the group ordered a prawns dinner, in which veggies, mashed potatoes and 3-6" long, but thick prawns were served and shared between pairs. Only a few were brave enough to continue to eat the Indian food and try the "Goan" staple foods, such as chicken xacuti. It can be described as a red paste-based with coconut milk and spices. After dinner, although most of us were full, Neeta suggested that we stop at Amici gelato shop. Great choice! It was on our way back from Martin's Corner, but definitely in the rural parts of Goa. It was delicious and well-worth the stop at 11 PM, as many of the flavors were phenomenal. No one left disappointed.

On Thursday, many of us woke up for a complimentary breakfast. They served both continental and Indian choices, such as masala tea, NesCafe coffee, Corn Flakes, hard boiled eggs and fresh pineapple. The new Indian food item was called sheera, a traditional Maharashtrian dish served at breakfast or as a snack. It can be described as an American "yellow sweet grits."
The rest of the day consisted of a City Tour of Goa from an estimated start of 10 AM to 6 PM.
1) Historical Portuguese Village
2) Hindu Temples (2)
3) Basilica of BomJesus in Old Goa (BomJesus means "Infant Jesus" or "Good Jesus"). This church houses the remains of Saint Francis Xavier. For more information, please refer to website:
4) Goa Beaches (2)
Many of the places, we were "tourists". However, we felt more like the attraction at some of the tour stops, as many groups and families would approach the group for pictures. Although it was a bit awkward to pose for pictures, it was enjoyable to see them all smiling and happy.

After a long day of riding in a bus, we wanted to have a low-key night. We ended up enjoying 30 minutes in the pool and then ate at the restaurant in the Nanutel Hotel. Some finished dinner to have a drink at the hotel bar, the Zodiac Bar and a bowl of ice cream from Baskin Robbins. What a long day!

On Friday, it was a very relaxing day. The only thing on our itinerary was our departure flight from Goa to Mumbai. We had the entire day to relax, sit at the pool, walk around "Old Goa" to buy "Tiffany cracker biscuits (which taste like animal crackers) and having a very late lunch at the resturaunt at our hotel. We left the hotel around 5 PM, but our flight got delayed, so again we had to wait around the airport. Finally we returned to Mumbai around 11 PM with little in our stomachs. Many people were feeling nauseated, tired and exhausted.

Friday, June 6, 2008

KEM Hospital (Monday, May 26)

This morning we had the opportunity to see the other side of health care in Mumbai. Previously we had been introduced to Saifee Hospital, which is a cutting edge private hospital. However, according to our guides, only 10-20% of people in Mumbai could afford to come to a hospital such as this. The rest of the people go to government-run hospitals such as King Edward Memorial (KEM) Hospital. We arrived and three of the therapists gave us a tour of their facilities. They had six physical therapy wards divided into areas for neuromuscular, musculoskeletal, and pediatrics physical therapy. Compared to the amenities seen at Saifee Hospital, the facilities here were in stark contrast. The patient-load was significantly higher for the physical therapists, and the equipment they were given to complete their jobs was significantly less. However, they loved their jobs. In fact, working at KEM was a very prestigious position as it was associated with the best medical school in the country. Besides seeing the areas where physical therapy was performed, we were given a tour of the pediatric intensive care unit. There we spoke with the lead doctor and he explained how the ward was run. We also had another chance to run into our acquaintance, Dr. Chlaga, the neurosurgeon that works at both KEM and Saifee Hospital. Finally our tour guides took us to their physical therapy school, which was attached to KEM, where they attended classes. This included a tour of their anatomy lab, cadavers and classrooms. After finishing up at the hospital, our tour guides surprised us by taking us to “Natural” Ice Cream shop, which probably is one of the best places to buy ice cream. We were most grateful for their kindness. After visiting KEM Hospital, we were the guests of honor at a ‘thank you’ lunch hosted by the National Association for the Blind. We met up with Asha and her NAB constituents at Samrat, a wonderful veg-tali restaurant. It was nice follow-up with their organization and solidifies the relationship with them. Asha and her colleagues were amazing hosts during our visit in Mumbai. We were very happy to meet up with them for a final farewell. We hope that we will have an opportunity to work with them in the future.

Our final adventure for the day included a trip to Elephanta Island. We took a 45-minute boat ride from the Gateway to India to the island. Once there we climbed the hill to the Elephanta temple. This is a Hindu temple carved into a rock wall. It was massive! There were several large rooms and intricate carvings depicting the Hindu god of rebirth. Not only did we see the caves, but we met with the other inhabitants of the island…the monkeys! They were very friendly and even posed for a few pictures as can be seen below. Our return boat ride was very relaxing and we had the opportunity to see the sun set over the skyline of Mumbai. It was a wonderful ending to a very adventure-packed day.

Sincerely, Chris

Addendum: We finished up the night by having a birthday dinner to celebrate Shefali's 25th with her parents at Mehesh, a great seafood restaurant near Mocambo.

Duke DPT Farewell Dinner

Saturday evening was the last evening that the entire Duke DPT team and our Mumbai hosts would be together. Therefore, we declared this our Farewell Dinner Night. Since the group had been such troopers with the local cuisine and heat, the dinner was arranged at an air-conditioned, quiet hotel restaurant that served continental food including steaks, chocolate cake and ice cream.

The evening was to both honor our new Duke DPT Alumni who have worked diligently for the past 2 ½ years to arrange this first Duke DPT Global Health Outreach Initiative effort and our very special hosts in Mumbai who assured our successful trip. The guests of honor were Aarti and Kapil Mathur who went above and beyond to ensure that we had transportation, clothing, food and water at all times. They invited us into their home on numerous occasions and included us into their family. For this we were extremely appreciative. The group arrived for dinner at 8:30 PM in their finest attire. The restaurant was small but had a beautiful ambience. The staff was very attentive to our very large and enthusiastic group. Choices included vegetarian and non-vegetarian fixed menus and most people ordered the grilled fillet since we had not had this option for the past 2 weeks. We sat among our guest hosts but even though the room was small, we could see almost everyone and could hear those not in sight. The room had great acoustics, as the tables were positioned underneath a circular ceiling. Everyone had a great time and the evening went quickly. Following the dinner some night owls decided to go to a local bar to continue celebrating and met up with some of the professional crickteers who were in the area for the championship. Since we now have a sense of how to play cricket and have been watching it on the local channels, we are beginning to appreciate the individuals who play and recognize who is on what team. The dinner and evening was a nice finale to our closure in Mumbai and we look forward to moving onto Delhi and Agra to see more of India and its culture and history.

Thursday, May 29, 2008

World Squash Association presentation (Saturday, May 24)

Mike quizzes the athletes - who wants a t-shirt?

Group picture of GHOI members and WSA participants!

After a long cab ride (~45 min in air-conditioned or for some, no air-conditioned "Cool Cabs"), we arrived at The Otters Club in Bandra. We met Amar, head of the World Squash Assoication, who quickly gave us a tour of the extremly nice facilities. However, we were in a rush to prepare the sessions and drills for the young athletes, so he led us to the squash courts. Three o'clock arrived fast and the kids were starting to gather. We gave them introductions and broke out into age-related groups, so drills and information were age-appropriate. We had four "stations" setup: warm-up, conditioning, plyometrics and strength training. At the end, we convened for a Q&A (question and answer) session, in which concepts that were taught to the partipants needed to be recalled correctly to "win a free t-shirt." The parents also joined at the very end for a Q&A session, in which they were able to ask group members about strength & conditioning. This ended up being a 1-on-1 session with the parents, but many of them left happy to gain this knowledge. Many of the kids, even the really young ones, were so polite and appreciative, as they thanked us before leaving. (We were also grateful as we learned from them too! During some of the activities, the children were able to teach us about proper mechanics and form of squash. Some of the members were able to join the kids for a quick teach & play game of squash!)
Afterwards, Amar and a few of the participants' parents invied us to stay at The Otter's Club for snacks and drinks near the pool and oceanside. We enjoyed ourselves thoroughly, as the view of the ocean was amazing and conversations with the locals was stimulating, as we talked about sqush and sports, travel, food, US and India. A few of our members even joined some of the children (who were at the program) for a game of "backyard cricket." The most rewarding points of the day were when we were all sitting with our snacks and tea at the table and the parents pointed out that the children are stretching after finishing up their activity AND they were asking for water to stay hydrated. That is really when we know we made a difference, as they were trying to make changes. Sadly, we had to leave this beautiful club, the families and the children, but fortunately we were able to walk out to a beautiful sunset! Sincerely, Mike

The highlight of the day (by Mike):
While working with the youngest group of partipants, I was trying to get them to stop playing on the physioballs but one child continued to play and bounce on it. I had no other choice but to physically remove it, as the child continued. As I tried to remove the ball, the child fell straight onto his buttock. I felt really bad and looked up to see Dr. Richardson staring at me. The child was fine, but I was scared!

Our last day at NAB (Friday, May 23)

Chris teaching the manual therapy techniques to the the NAB students while they feel his hands to learn the proper hand placement and movements.

Brienne and Claire speak to the NAB audience

So we are going to jump back to Friday, as we finish up our experiences with the NAB.

Friday morning was a bit of a "relaxing" morning...if you can call any of our days relaxing! There's just so much to see and do so we can get it all in! On Friday one group went to the Bombay Store to peruse and buy various gifts and Indian "knick-knacks" while the rest of the group went to get the chiffon Indian-style shirts (described by members of our group as the "ultimate wicking material" and "Indian UnderArmor"). These shirts were desired by many of the group members, to combat the heat experienced the day before. A room can get even hotter with 50+ participants performing manual therapy techniques in "what feels like" 100 degree weather (heat and humidity). Though the fans were surprisingly helpful, the shirts helped to cool our bodies during the teaching sessions. So this was our last day at NAB, the National Association for the Blind. Claire led the teaching of manual techniques for the spine, hip, and sacroiliac joint while everyone else continued to lead their small group of participants in hands on training.
Some comments from the group about our experiences at NAB:
Claire and Brienne: It was so fun to finally meet the people we have been corresponding with for over a year! Everyone was so humble and generous, and extremely gracious and inviting. It was interesting to see the differences between how we imagined things to be like and how they really were. We had been concerned about how the actual teaching of the visually impaired was going to go since none of have really done this before and didn't know what to expect. Working with a small group was good to give everyone the chance to both feel the technique as we were doing it, as well as try the technique on each other. It was surprising at first to have so many hands automatically feeling all over your own hands to "see" the technique. But after a while it became natural for us. I think as physical therapists we are used to using our hands a lot, so we were able to quickly adapt to teaching those with visual impairments. At the same time, it was impressive how quickly the participants caught on. It makes sense though, since they are so used to using their hands to interpret the world around them that they would learn quickly how to manage new technqiues with their hands to be applied to the human body. Finally, this group of current and future physiotherapists were inspiring. They in no way let their impairment limit them. We were so impressed with not only their knowledge and skills, but mostly their thirst for new knowledge. It was motivational for us as newly graudated students just coming out of school and feeling somewhat burned out -- we were able to see how excited it can be to have new experiences in physical therapy even beyond our formal education.
Melissa: One student (who was totally blind) asked Melissa to "take a picture" which really meant he wanted to video record her on his phone while doing a mini-interview to include information about herself so that he could remember her! During our tea break, we recieved umpa, which we could only describe as tasting like grits with veggies (but not so liquidy as you're probably imagining). It was made by "Mousey" (not sure on the spelling--but it means "Auntie").
June: Actually, I would suggest that the umpa could also be described similarly to chicken pot pie. Just thinking about it now makes my mouth water. The staff and students at NAB were extremely warm and friendly, as they opened up their school for us for three days and we will always be grateful for his experience! They provided us with everything we needed and gave us back much more! I hope that we get this opportunity again, as it was fun and rewarding for everyone involved!
Chris: Several of us received mahendi on our hands at the end. We spent over an hour giving out business cards and taking pictures (even the camera men wanted to pose in pictures with us!), and during this time Dr. Purnima (one of the NAB faculty) drew henna-like designs on our hands or forearms. She gave us the remainder of the cone so we could do more for the people that didn't have a chance to do it. Kara even tried her own hand at it and drew Rachel's design!
Mike: One of Mike's group members asked about pursuing further education as a physical therapist in the US. He was totally blind, but he probably had some of the best manual therapy skills of anyone in his small group! Mike was very encouraging and told him not to let go of this pursuit but to never take "no" for an answer.

At the end of the day, we left NAB meet the Mathurs at Bombay Blue for a mix of continental and Indian cuisine. The highlight: puffy balloons of fried dough (similar to puri, but I can't remember the name) and sizzling brownies from Mrs. Mathur (as a congratulations for completing our service at NAB!) Again, a very filling meal at 10:30 PM, but most enjoyable as Mr. and Mrs. Mathur made great suggestions on appetizer and entree choices.

Sincerely, Brienne & Claire

Monday, May 26th, 2008 - Saiffee Hospital & Elvis

Melissa here to recount our Monday adventures in Mumbai.
We were up early and in professional attire for our 2nd trip to Saiffee Hospital, a private hospital which overlooks the water and has been described as pretty as a hotel. At night you can see the lights of Saiffee from Marine Drive, the Queen's Necklace.
Professional attire to us means those nice wool suits or poly blends in black. Now add 100 degree weather plus 80% humidity and see how well you do in black polyester. This is a recurrent theme since we saw Elvis later in the evening in polyester and leather.
The professional dress that we were met by were nice kurtas and saris on the women and suits and ties on the men (no jackets that I saw though)
We were at Saiffee from 9am until 4pm. They have a very lovely auditorium with a reception area were we had lunch and broke for morning tea. Yes, they even take morning and afternoon tea during the regular work day in the hospital. The physiotherapists were coming and going throughout the day and many of them wore labcoats.
To give you a rundown of events:
In the am - Dr. Writer, the head of the Nieere (I completely massacred the spelling of that hospital but I do not have her card on me. That spelling is more for pronunciation.) Hospital Physiotherapy program - the Hindustani equivalent to Dr. Jan Richardson; she spoke to the audience on vestibular rehabilitation and then had 2 of her students present 2 different case studies for the room to discuss. For both of the case studies the patients were present with family and walked in front of the room. 1 case was of a 52 year old man with a 2 year old stroke with definitive right sided foot drop and hip circumduction. He did not have an AFO or an assistive device and his complaints were of being unable to walk more normally especially to safely walk across the street. Having spent a week in Mumbai by this time, I understand the absolute necessity to be able to safely and quickly cross the street. The cabbies don't stop, just honk!
The second case was a man diagnosed 1 and 1/2 years previously with Parkinson's and the question to the group was about how to progress his treatment. One of the major things we learned from this case study is that the physios here take alot of psychological/ psychosocial data into account and specifically use tests and measures to quantify depression or other issues that may be present.
Dr. Chagla, the neurosurgeon that we had met at breakfast at the Bombay Gym on morning 1 in India, got up to speak about "Sharpening your axe" - keeping up to date on research to be a better clinician.
Then 2 of the physiotherapists at Saiffee got up to present on biomechanics of the patello femoral joint and treatments of patello-femoral pathologies, specifically arthritis.
Dr. Pispoti, a rheumatologist who connected with us when we first wandered the halls of Saiffee hospital and discovered that he and Dr. Jan Richardson were both members of the Rheumatological Association (again - most likely got that name wrong but it's late for me writing this). He spoke to the group about discovery of joint pathologies via physical examination findings. It helps to reinforce the role of the physio for observing the big picture and referring out when necessary.
The Dr. Reepa Shroff, an occupational therapist, gave us an overview on Attention Deficit and Hyperactivity Disorder (ADHD) and Sensory Integration for the paediatric population. As I am a paediatric physical therapist myself, I was especially intrigued by this topic. My favorite line of hers is that "the child is the director but every good film needs a screenwriter/ the therapist."
Then we broke for lunch and had typically Indian Cuisine. The a couple of people in our group decided that the dessert, a coconut type milk with a sweet bread floating in it, reminded us of a bowl of milk that fruit loops had sat in for a while - that sweet milk flavor.
I sat between 2 very nice physios and we chatted. I have been continually amazed at how different the English language sounds from different parts of the world. I am sure that we, on both sides of the conversation, asked each other to repeat ourselves multiple times.

After lunch was our turn to present. Dr. Rachel Beck and Dr. Brienne Thorusen spoke on Evidence Based Practice. Dr. Michael Tamaddoni, Dr. V. Claire Maranto and myself spoke on the treatment of children with Cerebral Palsy in the United States, and Dr. Kim Elzinga, Dr. Chris Moldan, and Dr. June Lohner spoke about a Low Back Classification System as per Delitto et al.
I think the presentations went over well, especially since I got multiple email addresses with requests to send them our powerpoints and more information on other various topics.
Lastly, we were provided a tour of the rehabilitation facilites, the entire 9th floor of Saiffee. 2 things of note that we thought were particularly interesting was an electromagnetic bed for arthritis and also a CPM (Continuous Passive Motion machine) for the upper extremity.
That evening, we headed to meet Amar Hocksar and the Mathurs for a night at CCI (Cricket Club of India) with dinner an an Elvis Impersonator.
It was a very fun time in which we ate a mix of italian and lebanese cuisine and then danced to Elvis tunes.
The impersonator was very good vocally and in appearance (a younger version of Elvis in physique) but as Mike noted, his hips were just not right. Might have been because of trying to squeeze in black leather pants in Mumbai in the summer for an outdoors concert. He sang all the classics though, Love me Tender, Jailhouse Rock, and Teddy Bear. The group of us plus a small handful of the other patrons got up to dance to the King. We had a great time and I thought I had never sweated more until we got to Goa.
Of note, Kara Richardson, "swooned" when Elvis threw his scarf at her. Then she, as well as I and a few others of our party got our picture with him!
Last detail of the day - Happy Birthday Shefali! She turned 25 on this day and we went after Elvis to the Mathurs home to sing her birthday wishes and to have lime soda and mango and coconut ice cream in her honor. We were sad not to have Shef there especially on her birthday, but she was in our thoughts as we ate some of the most amazing ice cream ever. I highly recommend Mumbai in mango season.
Well it was a busy but fufilling Monday in Mumbai.