My First IRB Meeting

Last Wednesday, in the midst of the vaccinology course, I had a meeting with the Institutional Review Board (IRB) to get my research project approved. I had never been to an IRB meeting, but from what people have told me about typical IRB meetings, I thought that IRB committee would grill me on every little detail of the project. But then my project is an observational study using surveys, which means no risk to participants, so I wasn't too concerned.

When I arrived at the meeting place, there were a bunch of people waiting to be called in to get their study approved by the IRB. They all had a copy of their IRB application in hand, which made me realize that I probably should have printed a copy as well. Fortunately, I had a copy on my iPod Touch, so I quickly read through it to remind myself what exactly I'm supposed to be doing with my project. Well, apparently that didn't really matter, because the meeting turned out to be the easiest thing I've done for my project.

Basically, I walked into the room, which had desks and computers arranged into a very long rectangle, and I sat at the far end of the rectangle while one of the committee members summarized the objective of my study. I simply affirmed that that was what I was going to do by saying "yes." She noted that it's a well written study, another person representing the ethics committee said they had no objections or concerns, and someone at the other end of the room said, "Go ahead with your study." And that was it! It literally took no more than two minutes.

I wish all my future IRB meetings would be as easy as this one... but I suppose it can only get harder, like the one depicted below:

From ihasahotdog.com

Three Weeks In Review

View My Vellore Map in a larger map

Hey Everyone, after three weeks of hiatus, I'm back!

As I mentioned in my last post, I spent the first two weeks in a rural village called Kuvanur near RUHSA (see map) with the 2nd-year CMC medical students for the Community Orientation Program (COP). I stayed the first night with the guys at a school building, but I couldn't sleep too well because of all the noise they made (watching movies, playing music, etc) until the wee hours of the night. I don't mind sleeping out in remote places, but I think I'm too old for all the youthful late night activities (which I used to do when I was their age). After the first night I went back to Vellore each night with the staff, so I got to shower and sleep in my own apartment. So technically I've been "back" all along, but I just haven't had the chance to update my blog until now.

As you can see from the map, Kuvanur is a pretty small village. There are 371 households with a population of 1601, according our survey data. From what I gathered, many of them are farmers, but it seems there is a large variety of occupations and a wide range of socioeconomic statuses. This past week, the students analyzed the data that they gathered, made posters of the data, and presented them for the villagers to see. You can see a sample of the posters below along with some photos from COP.

This is where we held our meetings for COP.

The inside of the hut.

The school building in Kavanur where the boys stayed.

Inside the school building. The boys slept on the concrete floor.

Believe it or not, this is a woman's bathroom. How do they do it? There's a little hole in the corner that drains out... you can figure it out.

Another woman's toilet. This one is a bit more self-explanatory. Note that neither of the above models are for number 2.

This was our temporary garbage disposal and dish washing place.

Some of the medical and OT/PT students.

Kids from the village. They are cousins, and live next door to each other.

Water tanks like these are spread across the village. They are pumped with drinking water every 2 days for people to come and collect.

As part of the COP, groups took turns organizing games for the village kids each day.

As a service to the village, we cleaned up one of their temples one afternoon.

Students put up posters they made in the old school building.

A poster on population.

Can you guess what this poster is about?

I can tell what the graph on the left is showing, but not sure about the pie chart... maybe about how many are happy with their toilets?

Birth-control education poster made by some of the CMC med students. Look how happy (and wealthier) the family is with birth control!

Students performing for the village.

Some more dancing.

My COP group: me, Ranjana, and Nitin.

It was a lot of fun going around the village doing the surveys. Each group had a Tamil speaker, and both Nitin (the Tamilian in my group) and Ranjana (from Kerala, but speaks some Tamil) made sure I understood what was going on as we met with the villagers in our assigned area. So I felt very included even though I couldn't speak Tamil (thanks guys!). My group even let me lead the interview with one of the households, and they translated for me. During free times, I read some Colloquial Tamil to try to learn the language a little. I discovered that Tamil is surprisingly similar in structure and grammar to Japanese (and Korean). It's definitely a difficult language, but using Japanese as a reference has been quite helpful. Who would have thought Japanese would come in handy in India! Now I just need to find a good Tamil tutor so I can learn to pronounce correctly (assuming that's possible).

View My Kerala Map in a larger map

During the first weekend of COP, Lucy and I travelled by train to Kerala state (west coast of south India) for Anu Paul's wedding. Anu is a PhD student who works at Dr. Kang's (our mentor) lab, and is also a fellow Fogarty scholar. Her wedding was at St. Theresa's Church in Mahe. It was Catholic wedding rather than a typical Indian/Hindu wedding, so it wasn't as crazy as one might be, but it was really nice. I especially enjoyed the Malayali (Kerala) food. The fish taste so much better there than in Vellore. We stayed the night in Thalassery (8Km north of Mahe), and explored the city a bit the next day before we headed back to Vellore in the afternoon. Check out the map on the right to see where we visited, and below are some photos from the trip.

At Anu and Shijo's wedding, with the newly-wed couple!

My first train ride in India!

This is what berths (or beds) in sleeper class look like.

Toilet in the train. Everything basically goes straight down to the ground...

Boats in Mahe.

I found the Smart School in Mahe, but I couldn't find the other kind.

Overbury's Folly in Thalassery. A nice little park with a cool ocean breeze. Apparently it's a popular dating spot for couples.

Trying out some street food for the lack of better things to do.

I was told that banana chips are good in Kerala, so I bought a half-kg of them from this place..

Dried fish at the fish market in Thalassery.

During the second weekend, I went to Men's Hostel Day at CMC, which is the only day during the year where guests (other than family) are allowed inside men's hostel. Last weekend was Women's Hostel Day, which is the same deal for female students (but I was on my way to Kerala then). So each year the med students (all of whom stay in the hostel) put together a show and serve dinner to the guests, and invite them to see their rooms. I forgot to take a picture of their rooms, but here are some photos from the event.

At Men's Hostel Day, wearing my new dhoti, which I bought in Kerala. People were impressed that I tied the dhoti by myself, thanks to YouTube. In the back is a model of the Opera House made by the male med students as an art project this year.

Some of the male med students performed a short play called Blackadder. Simple, yet quite entertaining, and the guys did an excellent job putting it together in couple weeks.

A scene from Blackadder. The female costume (right) was a huge hit among the audience.

A vaccinology course lecture.

This past week I've been attending the 1.5-week long First Advanced Vaccinology Course in India at CMC. We have lecturers and students/participants from all over India and various places in Europe and the US. The course covers everything from basic immunology to history to the latest research and policies on vaccines. It took a little getting used to (and lots of coffee) being back to sitting in a classroom and listening to lectures all day, but it has definitely been an interesting and informative course.

Couple days after we got back from Kerala, I got a bit sick (probably flu or some viral illness), so I missed out on a few days of COP. I didn't feel too horrible, but I had to drag it out for the last week and a half. Thankfully I'm feeling 95% better now, except for the little discomfort in the belly, which comes and goes now and then.

So there you have it, my past three weeks! Thanks for reading if you got this far, and I always appreciate the comments. Praise God for an amazing experience so far!

To the Great Outdoors

Yesterday I finally submitted my IRB application! Hooray! I'm not sure what's going to happen now, but at some point this month it's going to get reviewed, and hopefully it'll be approved. Now I'm working on the questionnaire that my fieldworkers will be using to interview my subjects. I'm really excited about my project, and I can't wait to get things going!

Today I decided to take things easy since I had been staying up late every night working on the IRB application. So I did some laundry, went to the pool, and joined the church choir at CMC campus. They practice every Sunday from 4pm until 6pm when service starts. I hadn't sung in choir since college (wow, that's 4 years ago...), but I still remembered how to sing and read notes (I definitely felt a lot sloppier though). It was a lot of fun singing in choir again.

RUHSA

Tomorrow I'm going to RUHSA (Rural Unit for Health and Social Affairs), which is a department of CMC that is located about 30-min drive from the main hospital. As the name implies, RUHSA serves the surrounding rural areas. (More info on RUHSA here). Lucy and I went to RUHSA about 3 weeks ago and got a brief orientation there. This time we're going with all the 1st-year (soon to be 2nd-year) CMC medical students and OT/PT students for a 2-week long Community Orientation Program (COP).

Basically, we'll be spending the next two weeks in a small village called Kavanur near RUHSA. In groups of 3-4, we'll be going door-to-door to collect their demographic, socioeconomic, and health-related information, while learning to build rapport with the people in the community. It sounds like a great learning experience. I'm really excited because this will be very similar to how my research project will be done (although it will be done by fieldworkers that I hire).

The boys will be staying at the village throughout the week, while the girls will be staying at a hostel in RUHSA. I'm guessing I won't be having much internet connection while I'm out there, so you probably won't be hearing from me for the next couple weeks.

So just to entertain you while I'm gone, here are some random pictures:

Everyday, a herd of goats are brought to a patch of land by the main road that is piled up with garbage. It appears that goats clean up all the edible garbage (e.g. paper), while people burn the rest. Hmm... doesn't make a whole lot of sense, but it does make a lot of scent (it smells pretty bad—another good reason to have a bike, so I can zip past it while holding my breath)

A sign in the computer room at CMC campus library. Looks like the Lord isn't the only one who sees what you do there.

A mantis at the pool. This crazy insect attacked me while I was in the pool. It fell into the water, so I saved it. Then it kept following me... it must have thought I was its mate.

Urban Slums

Riding in the back of a motorcycle... without a helmet!

Most of the morning today was spent in one of the urban slum areas where the two cohort studies on cryptococcal diarrhea are done. Lucy and I had to each ride on the back of a motorcycle to get there because apparently it's very difficult to get around the area by car. We visited homes where children are enrolled in the studies. It was quite interesting to see the environments where people live. Even within the same area, there were big contrasts in living conditions among homes.

We also spent some time at one of the pediatric clinics, and observed a local pediatrician while she saw some patients. Most of the kids seemed to have upper respiratory infections.

Lucy on a motorcycle.

In the afternoon, we went to the Low Cost Effective Care Unit (LCECU), and met with Dr. Sushil John, who is one of the family medicine doctors there. LCECU provides care to the poor in the local urban slum at very low cost, and if they need a costly procedure or therapy, patients pay whatever they can, and the clinic helps find funding for them. Dr. Sushil gave us a little powerpoint presentation about LCECU which got me really excited, because it was all about what I want to do as a physician in the future. So I hope to learn as much as I can from LCECU this year, and apply it to my future practice wherever I may be.

After the presentation, we walked around the area near the LCECU, and met some of Dr. Sushil's patients at their homes. As we walked, he said things like "That man there has hypertension... this lady walking towards us had a baby with myelomeningocele... the man who lives here is an alcoholic... this boy has seizure disorder..." It was as if he knew everyone in the area, and it seemed everyone knew him too. People came up to him left and right with their charts just to update him on how they were doing, and he explained to us what were the issues with each of them.

The Low Cost Effective Care Unit.

Interestingly, patients at LCECU keep their charts with them at their homes, so when doctors from LCECU do home visits they would have their charts right there. It also saves the clinic a lot of money by not having to keep medical records. Dr. Sushil admitted that there maybe legal issues elsewhere, but here, having charts at patient's home is a very cost effective way that puts patient's care first. I definitely want to spend more time at LCECU during my year in India.

The long day was completed with a quick dip in the pool and meeting with some more international med students.

Praise God for another exciting day!

Shopping Spree

This week Lucy and I are meeting with various doctors and research officers to get a feel for the type of research projects we might want to work on. In the morning we headed over to the CMC hospital and met with Dhivya Anbu, who is a PhD candidate working on probiotics trial for prevention of diarrhea caused by rotavirus and cryptosporidium spp. In the afternoon we met with Dr. Rajiv Sarkar and Deepthi Kattula at Community Health Training Center (CHTC) on CMC campus. They were Fogarty scholars in the past years, and their research involves cryptosporidium in children (e.g. change in immune response over time in chronically infected children). Because our mentor Dr. Kang is in the gastrointestinal department, much of their research pertains to diarrheal diseases.

I have a lot of personal experience with diarrheal diseases (parasitic in particular), so I would definitely be interested in doing research in that field. We're scheduled to meet with people from other departments, so I'm excited to see what opportunities are out there as well. I can already tell that I'm going to have a hard time deciding on a project (or two) because there are so many different options here.

Harish Bakery

After our meeting with Dhivya in the morning, I went to the Eye Hospital to pick up my new pair of glasses (I can SEE now!). Then I walked over to Harish Bakery (my new favorite bakery in town) for lunch and got a variety of savory baked goods to go (I like their "puffs").

Next to the bakery is the Harish Grocery Store where you can get lots of imported food, toiletries, and household items (at marked up prices, of course). So I bought some food and a bunch of other stuff, such as insecticide spray, body wash, and hair conditioner (yes, guys use conditioners too... right? How else am I supposed to keep my hair nice and silky?).

One of the surprisingly expensive things in India is toilet paper. Four rolls of TP cost Rs180 (about $4.00)!

After our meeting with Dr. Sarkar and Deepthi this afternoon, I went over to the CMC College Store for more groceries, and stopped by the street vendors for some fruits and vegetables. I also got a new pair of sandals for Rs150 (compared to Rs180 for 4 rolls of TP).

One thing I couldn't find anywhere was insect repellent spray. The best I could find was insect repellent cream at the College Store. I'm not too worried about malaria since it's not endemic in Vellore, but I definitely don't want dengue fever.

I still need to buy some slacks and short-sleeve button-up shirts since a lot of men wear those to work here. I would wear shorts and t-shirts with flip-flops everywhere everyday, but I probably should try not to stand out too much.

Praise God for another great day in India! I actually felt pretty productive today, learning about all these research projects and getting a lot of shopping done. One thing missing from the day is a trip to the swimming pool, which unfortunately is closed on Mondays.

Europe in Vellore

Sundays are our days off, so Lucy and I spent couple hours at the swimming pool in the afternoon. It costs Rs200* to use the pool for a day, but we both got a 1-year membership, so we can go there everyday if we had time.

The pool is one of the main hubs for the many foreigners that come to Vellore (mostly med students rotating at CMC). So I got to meet several people from the UK, France, and Denmark. It was nice and refreshing to meet a bunch of people from various places. The place is well isolated from the outside world that, with all these Europeans, it almost felt like I wasn't in India any more. It's definitely a nice little getaway (and it's only a 15-minute walk from our apartment!).

Since we haven't started our research projects yet, I feel like I've been on an extended vacation... haha. I'm sure I'll get busy with work soon enough. I should enjoy this free time while I can.

After the pool I went to church service on CMC Campus. I came in couple minutes late because I thought the service was at another place, and when I sat down, I noticed that everyone around me were female. So for a second I thought I must have sat in the female section (not that I knew if there was one, but recently I found out that the seats on the left side of public buses are reserved for women). After a quick look-around, I realized that about 85% of the congregation were female. So I figured I was in the right place. It turns out all the nursing students were there, and they usually attend chapel at the CMC Hospital (which is different from Campus).

After chapel Lucy and I went to Dr. Kang's house, which is on CMC campus, for dinner. It was really nice getting to know her and her husband in a casual setting.

It was definitely a nice relaxing Sunday.




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*Rs = rupees; Rs200 is about $4.35.

CMC Tour

This morning Lucy (other Fogarty scholar) and I took the public bus to the CMC Hospital, and had a tour of the place. I was quite impressed with the facility. It made me wonder if I could work in a place like this one day, or even start a hospital like CMC somewhere. It was definitely inspiring.

In the afternoon we went for a swim at a swimming pool nearby. The place is very clean and well kept. We swam for about an hour, and now I'm exhausted. I'm so out of shape.

I need to start exercising again now that I'm not in med school... which means I no longer have an excuse (as if I ever had one).