Meeting #2 with Dr. Italia - May 23

Crazy right? But Dr. Italia wanted to make sure that I had all the material I needed to start putting together all my  documents. The better part of the morning was spent running a gel to check samples to see whether they were trait, normal or disease. The gel ran pretty late so we didn't eat lunch until around 2ish. But after lunch the girls and I spent a little bit of time discussing the meeting on Saturday with Dr. Italia and what we should start working on first. Soon after, Dr. Italia called Tanvi to go over the modified PEAS documents to see if an approximate score could be calculated. After going through the documents with Tanvi, Dr. Italia had me come to his office so he could show me some of the information that the program had already created so that I would not have to create entirely new information packets. It will be a lot of modifying existing documents to ensure that they meet the criteria set forth by the PEAS document. Our meeting ran until the end of the day but we managed to get a lot accomplished and from tomorrow onwards we will be able to make more headway with getting documents together and organized.

Vacation Day - May 22

No work on Sunday meant just a very chill day. I woke up late and I just relaxed all day. It was nice to not have to do anything but lounge around. I watched a movie, read a book, did a teensy bit of work but not too much and then went to bed :-P I know not terribly exciting but it was nice to not have to do anything, or go anywhere and just chill all day. 

Meeting with Dr. Italia - May 21

Yay!! Finally had the chance to sit down with Dr. Italia. Of course it didn't happen until 4:30pm when we had basically the entire morning free but that's ok. I'm just glad that we were able to go through everything and establish a plan of sorts. For the rest of my stay I will be creating a "booklet" to document the PEAS information that the program currently has. That way we can gather all the documentation and evidence in one place so that it can be referenced easily. I will also be helping with modifying an existing access database so that it suits the Valsad program more but a lot of the database work will be completed once I return to Pittsburgh. I am also going to help create a website for the Sickle Cell Screening Program which includes the mass tribal screening, newborn screening and the prenatal diagnosis. The mass tribal screening has been in place for the past ten years while the NBS program has only been running for the past two. There is a lot of data that has been collected but virtually none published so another goal is to publish the data that the Valsad blood bank is collected so others around the world are aware of the program.

    The Sickle Cell Program here was also recently awarded a Prime Minister's award which is a great accomplishment so it is even more important that information about the program can be found online. Right now, information is provided through reports to the National Institute of Health in India and through word of mouth. A lot of the work that I am currently doing involves learning how the current system works and how I can help the program. The girls and I will spend the better part of next week organizing all the information and putting together a manual that explains the goals of the project and action plans on how everything will be achieved. It was great finally sitting down with him but his phone must have gone off around 10 times in the hour and a half we spent with him and he answered every single call. Everything from work related stuff to personal calls. It's a very different mentality here where people will answer their phones at all times. Rarely do they ignore a call, even when they are in the middle of a conversation with someone else. They'll just pick up the call and talk until all their business is over. No, hey I am speaking with someone right now I will call you back later. Very different to get used to but there's really nothing that can be done about that. Our meeting with Dr. Italia ran almost until 6:45 so everyone rushed out so that we could go to the clothing store for some shopping.

     I have always wanted to buy a nice bandhani chaniya choli but they are very hard to find in Coimbatore. And if you do find them you don't really get a great selection since it is typically worn in northern India. I decided to capitalize on my visit here and get myself a nice outfit. Dhara and Ushma took me to this awesome showroom (name I can't remember anymore but apparently it's the best in the area and people from all over come to this store). I ended up buying this gorgeous pink/orange set but it is being stitched right now so I don't have any pictures. I wish I could wear it everyday though. It's made out of a type of silk and it's phenomenal. I am supposed to pick it up on the 25th so I will post pictures then :-)

This is an example of the bandhani "design"

   

Gujarat Red Cross Society - May 20th

Friday was all in all a pretty relaxing day. I observed more laboratory procedures and the girls and I went over the modified PEAS (Performance Evaluation and Assessment Scheme) document for newborn screening. We wanted to establish a baseline score so that we could see find a starting point. We still hadn't had our sit down meeting with Dr. Italia to discuss what exactly I will be doing so it was hard to start anything without getting his input and ultimately approval. So we basically decided to come up with ideas and small projects that we thought would be helpful and necessary so that we could give Dr. Italia the list to get his suggestions.

Dr. Italia runs two other pathology labs in nearby cities so he is always running around and very hard to track down. He is the director of the blood bank and all the programs within the blood bank but he is not paid for his position. He has been part of the blood bank for over the past 20 years and all his work is voluntary. All the girls say that he works 24/7 and is very dedicated to all of the projects he takes on. On top of all of this he is currently planning his daughter's 3-day wedding reception happening the first week of June.

    For example, today the Indian Red Cross society (Gujarat chapter) was celebrating their 50 year anniversary and there was a small program at the blood bank. Dr. Italia is one of the head members of the Gujarat chapter so he was leading the program. Somehow, I have no idea how it happened I ended up at the head table with all the other speakers and guests. One minute I am in the lab learning the different protocols and the next minute Dr. Italia has me coming up to the front of the room to introduce me and have me sit with him and all the other speakers. I had to sit for about an hour pretending to listen since everyone was speaking in Gujarati or Hindi. I only paid attention when I heard my name mentioned and even then it was a glance up and then back to people watching. The program was geared towards college students that were being "inducted" into the youth red cross society to help with blood donation camps throughout the state. Needless to say I was very glad when the program was over so that I could go back to the lab.

     Once the day ended it was time to come back and chill. It's been nice. We do something after work every other day so that way I'm not exhausted everyday because we finish work at 6 and then to go out after that everyday gets really tiring. Star movies is my best friend since that's the only english channel. Not even a single tamil channel so i've been watching a lot of movies. Some good, some I would rather have not wasted my time with but it's all good :-P

Birthdays and Shri Swami Narayanan Temple - May 19th

                  Today was Ushma's 26th birthday so we got to celebrate with cake. The entire morning was spent completing the rest of the steps for the beta thalassemia samples. Some of the buffers can be prepared in advance but one has to be prepared fresh the day of. The entire procedure is tedious and very time consuming because you have to immerse solutions in water baths for x number of minutes during which you really can't do anything significant. 

Ushma on Tanvi's lap

                   Everyone worked on the procedure until 3 which when we ate our lunch. The girls have been ordering lunch for me from different places everyday so that I can experience all the different types of food. It's been a lot of fun eating lunch with the girls because they all share their food and it's basically one huge picnic every day. I've gotten the chance to try a lot of different types of food that is unique to Gujarat. There was a lot of extra food today so by the end of lunch everyone was stuffed and we still had the birthday cake Ushma's husband had brought her in the morning.
               After lunch it was finally time to finish with the beta thalassemia samples.

 

The ten membranes on the left and analyzing the variants on the left

The rest of the afternoon was spent setting up yet another procedure (this one testing Sickle Cell samples) that will be completed and analyzed tomorrow. Everything was finished up around 5:15 so we decided to celebrate and have Ushma cut her birthday cake. 

 

Ushma's birthday cake

              After work Riddhima took me to the Shri Swami Narayanan temple which was along Tithal beach where we went on Sunday. It was gorgeous outside and there were a ton of people at the beach again. The architecture of the temple is gorgeous and it was a really nice place to visit. 

 

The temple was so pretty

The view of the beach from the temple

I'm easily amused

After visiting the temple we went back to the first part of the beach to people watch and enjoy the weather. Got to see the camels again and I couldn't resist taking pictures especially since the sun was beginning to set and the backdrop was gorgeous. 

 

 So pretty. I want to go on another camel ride lol

Learning Procedures and Shopping Part 4 :-P - May 18th

So today we tested the samples that we had collected from the various health centers the day before. There were 58 samples in all that were being tested for sickle cell. The procedure is a lot more tedious because many of the steps that are done by machines in the US have to be done manually here. Because of this testing all of the samples is virtually an all day process. At the PerkinElmer lab in Pittsburgh they screen over a thousand samples a day for sickle cell but here they can maybe do around 200 samples? Maybe a little bit more. The machines takes about 3-4 minutes to analyze each sample so 20 samples can take 1 hour. With our 58 plus the 11 markers it took about 4 hours plus the 2+ hours in preparing the samples and inputting all the patient information. It was really interesting to see the steps and methods that are taken to prepare samples and analyze them and compare them to the process in the US. Here, Ushma, Tanvi, Riddhima and Dhara are responsible for pretty much every aspect of the entire newborn screening program where in the US each section is handled by various members. The four are also responsible for the prenatal diagnosis program and are routinely called to help with Blood Bank activities as well. In the past two years they have managed to screen close to 5,000 newborns which is a great accomplishment.

 

The filter paper samples

The stack of samples that had to be entered into both the computer, the analysis machine and hand written into the data book

          At the end of the run we had identified two traits among the 58 samples. The samples for the two trait individuals will be tested again to confirm the result. 

    

          When we had some breaks in between procedural steps I explained all the material that I had brought with me. I had a lot informational packets from different hospitals and sickle cell centers to show how SCD was explained to parents and children. I also explained the access database that Dr. Krish had for tracking sickle patients that could be used for the Valsad program after some modifications. The program as it stands right now is really great. I think a lot of what I am going to be doing is fine tuning some of the organization and putting everything on paper to create a manual describing the program and the goals and how the group is accomplishing their objectives. Everyone was very receptive to all the material that I had gathered so far and it looks like I am going to have fun working with everyone to put together the manual. 

             We spent the end of the day starting the procedure to check samples that have tested positive for beta thalassemia to identify which variant is responsible in each case. By the end of the day tomorrow we will have the results and will be able to identify exactly which mutation is responsible in each case. 

 

Ushma and Dhara setting up the membranes for the CRDB procedure

After work Ushma took me to yet another jewelry store so that I can buy even more jewelry. You can never have too much right? Though after this trip I think I'm staying away from jewelry stores for the rest of the trip here. The store we went to today was even better than before and I ended up buying even more stuff but I just couldn't resist. Here's a preview because I just can't put everything that I bought on here:

 

The ring on the left is for my sister and the one on the right is mine

 

Ring/Bracelet combo and a Sari hook

 

The blue bracelets are for Maria and her sister and the gold peacock bracelet is mine

If you want to see more pictures let me know and I'll send them to you because there are waaay too many to post on here. 

        

Primary Health Center Visits - May 17th

For the newborn screening program, the workers at the blood bank routinely visit the different health centers in the surrounding area to collect the dried blood spot filter papers to do the testing. The blood bank provides all of the centers with filter paper (similar to the ones that the US uses) and tubes so that when a baby is born the cord blood can be collected and sent for testing. We spent today visiting four different health centers and hospitals collecting the samples and replenishing the supply of filter paper sheets and collection tubes. We left the blood bank around 10:30 and didn't get back until 6pm so it was definitely a long day. Riddhima, Abhishek, Jathin bhaiya (the driver) and I went on this trip. By the end of the day Riddhima and I were fast asleep in the back of the car because the drive back from the last health center was 3 hours.

It was a nice trip in the end though. It was cool to see the various health centers and see another aspect of the NBS program. In the US, the hospitals directly send all the samples to the laboratory but here the lab personnel have to go and collect all the samples. Collections occur at each center/hospital around 3-4 times a month. So the turnover of results is not as quick as in the US either.

 

Two of the health centers that we visited. Dr. Abhishek giving the nurse the tubes and filter paper cards

 

Sickle Cell Disease information at one of the centers

After we made stops at all the centers we stopped at the Botanical Garden to eat our lunch. The garden was gorgeous and it was nice to stop and walk around a bit after sitting in the car for so long. 

The entryway of the gardens

 

Our lunch spot on the left

Part of a train that was in service from 1920-1936

We stopped at a small Hanuman temple on the way back

Since Riddhima and I were falling asleep on the way back we decided to postpone our trip to the temples for tomorrow. I could barely keep my eyes open when I got back to the blood bank and have been half awake while typing all this up so it is probably a good thing we didn't go anywhere else today or I really would not have enjoyed it. But I am looking forward to seeing more of the city in the next two weeks. :-)