Mumbai

View of Mumbai

Mumbai was my final stop in India. I discovered that the places I wanted to go where far away from my hotel by the airport. I stayed at the Mirador Hotel which was amazing! I was so well looked after there, so if you want to be close to the airport it is a brilliant hotel. I was collected and returned to the airport, they booked me Ola taxis to go out and made sure I went out with the duty managers phone number in case I had any problems. The service was incredible.

Gateway of India

My first stop was to the Gateway of India. This gateway was built to commemorate the arrival of King George V and Queen Mary to India. The British army left via the gateway once India had its independence and now it stands in front of the jetty where boats depart to Elephanta Island.

Faces of Lord Shiva

Elephanta island was a much longer boat ride away than I had anticipated. The caves are up a long flight of steps, which double up as a market. Rather than pay 1500  rupees for a guide from the jetty, I hired one inside for just 500 rupees. There are a collection of caves in the site, but only one of them has statues inside. The temple is carved into the rock and is for Lord Shiva, although it was greatly damaged by the Portuguese, so is no longer an active temple, but is still a world heritage site. Inside there are 9 depictions of Lord Shiva, all intricately carved so you can see other images through columns. The cave pillars have been restored, so are now part rock and part concrete. It was a very interesting place and I am glad I hired a guide to explain the different images to me.

 

I also visited Oberoi mall. Like every mall in India, you have to go through security and bag scanning to enter. It is a relatively big mall with high end shops, so is a great place if you want to go shopping. It was only 20mins away from my hotel and comes complete with a cinema.

 

I was only in Mumbai for 48 hours, but would definitely go back as there is so much still to see. It is much more humid than Delhi was, so make sure you carry and drink lots of water.

Private Healthcare in India - Imaging

CT Brain

So I spent part of the day with the Dr who reports the CT/MRI and x-rays. It was both interesting and boring all at the same time, so I am afraid this will be short, as I have defected back to the ED (again... Sssh don't tell HR).
The scan or x-ray itself is performed by a technician. The x-rays are printed out onto film and examined against a light box, whereas CT/MRI seems to stay on the computer to be reported. I have seen people with film prints of their CT/MRI scans, but I am focusing on how things are reported. The Dr then looks at the images. For X-rays the result was written on the envelope flap. MRI and CT reports were hand written into a book. These hand written reports are then given to a typist, who selects the report format and transcribes the report onto the system and prints it. The Dr then gets a pile of reports to sign. It all seems more complex than it needs to be - but such is healthcare.

I learnt a lot about looking at chest x-rays as there were a lot in the pile. Unfortunately I quickly forgot all the actual names for the anatomy and so am reduced to referring to the 'pointy angle at the bottom' to describe how to find out if there is pleural effusion. I also got to see one with a pneumothorax (pure black space - no white blood vessel shadows). I also got to see some MRI heads to look at sinuses and a CT brain, which was fascinating. Eyes in particular look amazing in scans, well to me anyway.

I warned you this would be short - I was only there for 4 hours.

I have had an amazing time at the hospital - I am absolutely gutted that I have to leave. I have learnt so much in such a short time and the whole ED team in particular feel like family. Indian people are so kind and genuine and it has been a pleasure to learn from and with them.

Amritsar

Golden Temple

I made the 7 hour train ride from Delhi to Amritsar. My first stop was to Jallianwala Bagh, the memorial garden to the Indians killed by the British on 13th April 1919. It is a maintained garden with a little museum with the history, which was very interesting.


Jallianwala Bagh Memorial

Next door is the Sikh Golden Temple where I went for sunset. The complex is white with the Golden Temple sat at the centre of water. I joined the que (well, more mad crush) for an hour to go inside the temple itself. I am not Sikh, so didn't really understand what was happening. If you are visiting you will not be missing out on too much if you just view the temple from the outside. The crush wasn't really worth it, but it is pretty inside. At 7pm they have prayers which was nice to see. You have to leave your shoes at the shoe house and make sure you cover your head to go inside.



Golden Temple by night

The next day I visited 2 Hindu temples. The first was Durgiana which is a smaller scale version of the Golden Temple. It was a cute little complex and pretty quiet with a free shoe house too. I then went to Mata Lai Devi Mandir temple. This was amazing and words/photos don't really do it justice. It had cave entrances and tunnels and is something you should go and see if you are in Amritsar. You start off by going upstairs on the left and follow the one way system back round. It is full of beautiful decorations and was an experience in itself.

Inside Mata Lai Devi Mandir

I also spent a lot of time in the markets. I wanted to buy something similar to an Indian suit but a lot of places sell them unmade, so you need to spend extra on tailoring. I went to a shop that sold them ready made and bought a gorgeous dress (if I can call it that) with leggings for 850 rupees. There are 3 main market areas - the one around the temple, a fabric market and a shoe market. The latter is each a labyrinth of its own, but occasionally a rickshaw appears if you wish to escape. There are so many beautiful clothes on sale there.

 

The train was also interesting. Being in an air conditioned chair class, with a hot meal each way. The food was like poorer quality airplane food, but you do get a free 1L bottle of water. It is definitely a relatively cheap way to travel - just take an anti-bacterial wipe - the tray tables are super dirty.

 

I would definitely recommend an overnight trip to Amritsar if you are ever in North India. The temples are beautiful if nothing else.

Private Healthcare in India - Operating Theatres

I have moved from the emergency department to operating theatres in Delhi.
 

The first thing you notice in this hospital is that some of the theatres operate with their corridor doors open. In the UK each theatre has an anaesthetic room leading to theatre and you need to pass through 2 doors (which shouldn't both be open at once) to get into the theatre. There are also only 2 sinks in the corridor to scrub up in, whereas in the UK each theatre has a sink inside for you to do this.

 

Inside an Indian operating theatre

The most striking thing in India has been how much is reused. In theatres all the drapes and gowns are made of material and are kept, washed and reused. In the UK almost everything is disposable - gowns and drapes are all binned once the procedure is over. Clinically, however, the procedures are the same as they would be in the UK, if not slightly more advanced at times. There is also a pharmacy in the operating theatre department, so there are no cupboards in theatres with medication stock.

 

I am also in awe of the respect shown between the staff. Nurses are frequent called sister or brother, whilst Dr's are called sir or ma'am. I think this is amazing as in the UK we often call each other by first names, or you just hear the terms nurse or Dr. This respectful culture is definitely one that I think is great, especially as I am not a fan of being referred to as 'nurse' when I am at work. However, the hierarchy in theatres is clear - the Dr's have a spacious lounge, whilst the nurses have something near to a shoe box with curtains to change behind and a table in the middle. The nurses also have a different coloured uniform to the Drs, which I think is actually quite useful as in the UK often everyone in theatres is dressed the same, making it impossible to tell who is who.

 

I have been privileged to see several caesarean sections, including one for twins. I have also had some brilliant surgeons explain what they are doing along with others that work in complete silence. There is a separate little room in theatres with the incubator table and neonatal equipment.

The neonatal room

I have seen a lot of laparascopic procedures which has been interesting. Mesh for a hernia repair costs 43000 rupees.

There is also a pharmacy in theatres. I assume that alongside the cost of your procedure, any drug used is obtained from pharmacy and added to the bill. There are no real stock of drugs or dressings in the theatre itself, everything comes from pharmacy. Most wound dressings are just gauze and mepore rather than complex or waterproof as in the UK. Anything additional to your procedure is added up - each bottle of saline and each vial of antibiotics. Most people seem to be cash patients, rather than under any insurance.

You can also be operated on a lot quicker - one patient had only presented to outpatients an hour before she was having her procedure in theatres. Otherwise clinically things are relatively similar to practice in the UK, just in a very different environment. Next week I am headed to MRI/CT so I can look at pretty images

Private Healthcare in India - Emergency Care

As I travel around in Delhi, I can see just how many private hospitals and clinics there are. I am currently in the Emergency Department of one of them.

According to one of the Drs only 0.3% of India's 1.3 billion population has private health insurance.

So, what happens when you arrive in the emergency department:

1 - If you are involved in an RTA, are poisoned, attempt suicide or assaulted you become a medico-legal case. These are all reported to the police and then 2 fingerprints are taken.

If you come in for any other reason then you go any pay at the reception desk. I haven't been able to find out the finer details for this as different people seem to pay different amounts when they arrive. They then show the Dr the receipt.

2 - You are seen by a Dr. There is no waiting to see a Dr as there are 5 per shift dedicated to the emergency department. Nurses cannulate you and the Dr tells them if you need a blood sugar, bloods or an ECG. Every procedure is documented so you can be charged for it.

3 - If you need medication or a dressing then you go with the order and buy this from the hospital pharmacy.You then come back with everything you need for the intervention and give it to the staff, who then administer the drug or do your dressing.

4 - You may get seen by a speciality Dr. The emergency Dr's like to do this as then consulting fees can be added to your bill. If you need an ECHO, ultrasound or x-ray and can pay for it then you go straight away. If your insurance doesn't cover you or there are issues paying then these will wait until you are admitted.

5 - If you are admitted you have to take a form to admissions and get allocated a bed in the hospital. There aren't really any speciality wards and you chose from a VIP room, double or 4 bed room.

If you are discharged  then your bill is calculated. It costs 850 rupees an hour to be in the emergency department and 200 rupees to be cannulated (this is basic cannulation without a tray, which means no flush, no special one way valve, just clean the skin and insert the cannula). A whole cannulation tray costs 1000 rupees.

At this point a lot of people seem to self discharge at this point as they cannot afford a hospital admission.

The Golden Triangle

One of the things I would recommend is to visit the Golden Triangle, consisting of Agra, Jaipur and Delhi. Our trip was arranged and we were provided with a guide at each location. The current exchange rate is approx. 80 Rupees to £1

 

JAIPUR

In Jaipur we visited Amber Fort. Elephant rides are a very popular way of getting up to the Fort, but this is only possible in the morning and comes with quite a queue. You ride side saddle in pairs along the edge of the drop, so you get a stunning view. There is a 21km wall - the 3rd longest in the world surrounding this and 2 other forts in Jaipur. There is a cost of 500 Rupees entry, unless you have a student card, which makes it a lot less, but the elephant ride cost is separate to this.

Inside Amber Fort

Amber Fort

There are also a few places to add as photo stops: palace in the lake and the palace of winds. The latter being a building with lots of windows, where women would stand to watch processions and life below as women were not supposed to be seen.

Palace in the lake

Palace of Winds

Jaipur is also a very good place for shopping and specialises in semi-precious stones and there are lots of places to buy clothes and textiles.

You can also visit City Palace, home of the King for 500 Rupees, or less if you have a student card. There is limited areas where you can take photos inside and if the little flag is up it means the King is there. Apparently if you pay extra you can go and see him.

We also visited a place called Monkey Temple, just outside Jaipur. It is 50 Rupees to use a camera and the guide helps you with the monkey, who you can feed (food may cost extra). The guide was brilliant and made sure the monkeys didn't get aggressive. They are wild monkeys who come in from the surrounding rocky hills. It doesn't appear to be a functioning temple, but is full of 2 different monkey species, all of which you can feed. The guide was key in helping anxious people (like me) enjoying the experience of feeding monkeys in this beautiful setting.

AGRA
The first thing we did was go to see the Taj Mahal. We were there before 8am and even then it was quite busy. As a foreigner you pay 1000 Rupees for a ticket, which includes free shoe covers to wear in the mausoleum, a bottle of water and a ride on an electric car down to the monument and back. It is the tomb of Mumtaz, 3rd wife of Shah Jahan (Mogal King). It is built of white marble and the whole complex is symmetrical. It is currently in the process of being cleaned, so parts of it are under scaffold. It is an amazing piece of architecture.

 

Taj Mahal

We also went to Agra fort, which is built from a mixture of red sandstone and white marble. You can see the Taj Mahal from it as well which allows you to see the Taj Mahal from a different angle. It is 550 Rupees entry, but if you have your ticket from the Taj Mahal it is only 500 Rupees. Part of the fort is still used by the army, so it is not fully open to the public but you take photos everywhere.

Agra Fort

DELHI

I have covered some of Delhi in my previous post, so this is about the places I have been to since my last post. There is so much to see in Delhi and so much beautiful architecture to see.

The lotus temple is a Baha'i house of worship; built in the design of a lotus flower with a grand total of 27 petals and surrounded by 9 pools of water. It seats 1300 people and has no imagery inside as it is a place of prayer and meditation for those of any faith. Baha'i faith is an independent world religion, aiming to unite the people of the world into one cause and one common faith.

Lotus Temple

Humayun's Tomb

Humayun's Tomb is on a complex with other grand tombs and burials and costs 500 rupees to enter. The tomb itself is 47m high with a 6m gold plated fixture at the top. It is built of red sandstone and predates the Taj Mahal. It was built by the wife of the Moghul emperor following his death.

Qutub Minar is also 500 rupees for entry to the complex containing the 72.5m tower. It is built on a site where Hindu temples were destroyed and a Mosque built in its place. Most of the site is ruins, but the tower is complete and towers high above you. There is also an iron pillar which has not rusted which is an interesting addition.


Qutub Minar

 

There are also a whole range of Hindu temples which you can visit, along with a Sikh temple and the Red Fort. Most of these are accessible from the metro, with or without a ride on a tuk tuk to get you to the entrance. It is a city with so much to explore and discover, including museums and parks.

The Golden Triangle has so much to offer and is definitely worth exploring if you are in the north of India. The architecture alone is amazing and worthy of seeing in a busy schedule.

Delhi

I have arrived in Dehli!!! Oyster Worldwide have been great and very involved in getting me here, with lots of support and advise/information before I left. I would recommend them as a company to volunteer through.

There are a grand total of 10 of us in the flat, all on different projects. I got taken out to buy a SIM card which was an experience in a questionable basement. They copy your passport and VISA and you need to give them a passport photo in exchange for a SIM card, then wait 24 hours for it to activate so you can then ring a number to make it function. They seem to deduct quite a lot in tax, so I would advise topping up with a decent amount of money.

We have braved Indian roads in auto-rickshaws to go to Iskcal temple:

We have also been to Lakshmi Narain and Akshardham Temples, the latter holding a Guinness world record for being the largest Hindu Temple in the world. Arksharham opened in 2005 after 5 years of building and is a must see. The intricate carvings on the 234 pillars and ceilings and 148 elephant sculptures surround it are absolutely stunning. Entry to both was free, but you are not allowed to take cameras or mobile phones into the temples. The security is very tight on this and there are places to deposit your things and shoe-cloakrooms for your shoes before you enter. 



Laxmi Narain

Akshardam

I have also been to the world war 1 memorial, known as India Gate. It is an arch at the centre of a roundabout with the names of those killed carved into its walls. It was quite a busy place and the surrounding road is also very busy.

India Gate

Indian roads are interesting - lots of horns blaring, weaving lanes, barely and indicators and as one of the others said "aggressive driving needs aggressive pedestrians," especially if you want to cross the road.