The past two days have been very strange concerning my project. The status of the enteric diseases study was in limbo as of last week, with me still awaiting approval from the IRB, and not knowing what type of support I would receive from the CD Hospital. Now, shortly after receiving approval from the Office for the Protection of Human Subjects in Chicago, another visit to the Ripon buildings to meet with the Chief Health Officer has changed everything. Firstly, the Dr. Kuganatham wanted me to remove patient incentives as a part of the study. Oftentimes some type of financial reward is given to participants to increase enrollment and under the time constraints of our project it was assumed that this would be a necessary requirement. However, because we are working through a government hospital it was thought that this could open a ‘Pandora’s box’ wherein patients could expect a financial reward for future studies or draw the suspicions of politicians who could question why we needed to give these parties money (were they incurring some risk to physical harm to warrant this money, why only 200 rupees, etc…). This concern makes complete sense, but it is another bureaucratic hurdle to overcome, necessitating a further human subjects review, to begin actually screening patients. Next, a state epidemiologist from Tamil Nadu suggested that with only 100 patients we would have a somewhat weak power to detect statistically significant associations I agreed with him but explained that this was a pilot project intended to inform future studies in the region. This, coupled with a comment I’d made that there hadn’t been a multi-species study of acute diarrheal disease causing organisms in Chennai since 1992 (the O139 V. cholera outbreak I mentioned several posts ago), prompted the Health Officer to decide that this type of study needed to be undertaken. He recommended that we increase our sample size to 500 persons (another IRB review) and that the Corporation of Chennai would undertake the extended screening for a diverse scope of pathogenic organisms including but not limited to Shigella, V. haemolyticus, Salmonella, Enteropathogenic E. coli, enterohemorrhagic E. coli, Giardia, many helminths and amoebas, and of course our original organisms of interest the coccidian parasites. Needless to say I was terribly excited by this comprehensive study (especially after being nervous about if anything would get done with this project), but that enthusiasm was tempered by the knowledge that this study would require a great deal of paperwork to be completed in very short order (it isn’t some much completing the items but rather hearing back from the reviewers.) This type of comprehensive study was what I envisioned the next stage of my project to be and I hadn’t seen anything similar to it(at least any publicly available data) from journals concerning southern India’sprevalence of enteric pathogens during my literature review.
There is another potential downside/opportunity to this. It could likely necessitate me being on site for the project until mid-September. This is problematic for several reasons: Classes begin on the 24th of August (I would be missing at least 18 days of class), I have told my employers in Chicago that I’d be back in the middle of August (would I even be eligible for assistantship?), I’d be missing an important non-UIC exam date, will reallocation of funding in the grant lead to me not being reimbursed (-$1000 dollars could hurt), and I’m impatient to see family and friends once I get back. To top it off, I don’t even have internet access at home (I haven’t for over three weeks now), so I can’t communicate any of these concerns with anyone over Skype. All in all I have some important decisions to make in the next couple of days. The concern about classes doesn’t bother me too much. I feel that experiences within your field trump text books any day (why have I been in school so long then?), but the concerns about employment raise some issues because aside from my plane fare I have been paying for things on this trip out of pocket which will become more troublesome as I stay longer (plus I think there is a $200 dollar charge for changing my flight). I still can’t believe how the entire outlook of my trip could change over a several hour meeting, but Mr. James, the chief lab technician at the Communicable Diseases Hospital, tells me that these grand reimaginings of public health projects are characteristic of Dr. Kuganatham.
Outside of work I have been going to several nice restaurants since my bout of food sickness last week. Some of the most memorable places include Inseoul my new favorite Korean restaurant and Amethyst a multi-cuisine restaurant (multi-cuisine typically means that they have Indian and Chinese dishes and occasionally continental cuisine). I’ve gone to Inseoul several times now and it never ceases to impress me. I’ve probably tried nearly every Korean restaurant in Chicago and none of them really compare to the food here. For 300 rupees (~$6) you get an outstanding assortment of (unlimited) side dishes and the entrees are typically big enough for two people to share. On top of this, I didn’t think I would be eating bulgogi at any time during my stay in India, but this place’s beats out any that I’ve had before. The restaurant is run by a Korean family and is constantly packed with Koreans and the occasional Caucasian business group enjoying the traditional Korean style seating. Amethyst is located a bit farther from the guest house in Alwarpet but it has amazing outside seating. The garden seating twists restaurant goers into secluded areas and the dense trees and plants occlude sounds from the noisy streets nearby. They also have remarkable food and I had some type of whitefish fillet with chili, lemon and some other spices thrown in which definitely made me want to go back. Lastly, I read an article about an Indian chili the bhut jolokai (King Cobra Pepper, Ghost Pepper, Ghost Chili, Naga Chili) which is said to be the spiciest in the world. It is currently being weaponized by the Indian army to control rioters. Since I read about it I’ve been trying to find some in Chennai (it isn’t native to the south but rather northeast India) but have been unsuccessful. Hopefully with some luck I’ll be able to try it before I leave. Friday of this week I am leaving Chennai for Hyderabad on another overnight train. The distance is about 700km north west of Chennai and it should make for some great sight seeing as well as work-related travel. I will be back in Chennai Tuesday morning when I can hopefully share some photos of the trip. I hope everyone back home is doing well and that with some luck, if I’m ever able to get the Airtel people to fix the internet, that I’ll be able to talk with you.