Healthcare in the Himalayas

But like, kind of like things are escalating now. She's going and talking to this other person, having her lay down and do like an ultrasound. It's also hard to explain that. And now and then at this point, she, like, really starts freaking out because she's like, like, what do you mean? Like, I just have a headache. Why are you doing an ultrasound on my eye? Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. Welcome back.

Welcome back to you. You're the one who's been gone.

Welcome back to our listeners. Yes, I'm back, everybody. Ten toes down in the United States of America.

She made it back after quite a long journey.

Mm. Yeah, that's what. When people keep asking me about how my trip was, I just have so much recency bias of what the last, like, five days were. So it's hard to kind of step it back. But, well, let's try to go way back.

So way back to the end of June, we took a family trip to Japan, which was super fun. Got to spend time together, do a bunch of fun things. But then the rest of us flew home from Japan. And you flew from Japan to New Delhi and that.

Yeah, I did not realize how far away Japan and India were when I planned this. I was like, oh, I'll just pop right over. Yeah, no, that was a nine hour flight. And then I flew from India back to Houston the other way around. So I went all the way around the globe this summer. Circled the globe, circled the globe. But yeah, that was a lot. That was a. That was a further flight than I thought. But, you know, I mean, there's no.

Way you could have had that information. No way to know.

Asking me how far the. Like, oh, I'm going to India. How far is the flight? Like, I don't know. Like, why does it matter? I'm gonna get on the plane and then I'm gonna go.

Like, it's not like you're driving the plane.

Yeah, I'm. You just know it doesn't. I know it's long. I don't know. I feel like the difference between a 8 hour plane ride and a 13 hour plane ride isn't that different to me.

No, it's not. Anyway, so you got. So you got on the plane, you went to India, and then what happened?

So the reason that I went to India is for this global health trip that I talked about on a previous podcast episode. But I'll go kind of more in depth to what I did, because when I was talking about it, I honestly, like, didn't really know what I was doing or, like, I. I knew that I was going on a global health trip to India, but I honestly didn't really know any details at all. You know, whatever. I went with five other people from my class, and then the whole group was about 30 people from all over the world. There were people from. There's a big group from einstein. There's like 10 kids. All that's in New York. And then there was a group from Cambridge in the uk and then a group from Belfast in Ireland.

Oh, they're from Northern Ireland.

And then from. And then there's a group from. Or there's someone from South Africa and some Canadians. So. Yeah.

And then you develop any accents, such as Irish or British or South African?

No, I. I definitely picked up on some lingo. Like, instead of saying thank you, just cheers. There was a lot of conversations about that. Like, stuff they said, you know, it was dark outside. And then I was like, someone's like, oh, well, let me get my torch out. And they got their. Their flashlight on their phone. And I was like. And then. Yeah, that caused a lot of things. I was like, that's not a torch. What do you mean, torch?

That's really funny.

An intense word. And then I was like, no way. And they're like, no, that's what it says. Like, on their phone. On the flashlight app, it says torch Tor.

That's really funny.

Yeah. Yeah, it does sound so medieval. Okay. But, yeah, so before we met up with, like, all the other people, me and three other girls from my school did, like, a trip. Did, like, five days doing what's called the golden triangle. So we did. So this was just tourism. So we just, like, did five days of just, like, tourism stuff before we started on this global health trip. So we saw the Taj Mahal, or we did a day in Delhi, then we saw the Taj Mahal Hall. Then we went on this safari, and then we. To Jaipor. And then we came back to Delhi, met up with the rest of the crew, and then headed up to the Himalayas.

Okay. Yeah. And so then you.

You all got.

So you all met in Delhi with the whole group, and then you flew together to Chandigar or something, right?

Chandigar, yes. So, yeah, the tourism was. Was really fun. That was like. Like, we were staying at, like. Like, you know, nice or hotels. And, you know, it was very. It was really nice. And then we kind of. It was Very different from the. The main part of our trip, which we went and flew to Shandigar. And then the idea was we were going up into the Spitty Valley region. So we started still like way up north in northern India, but we started south and then kind of did this loop up through the Himachal Pradesh region is what it's called. And so we were like driving from town to town doing different. Doing clinics in each place.

Okay, and what kind of conditions were you staying in?

So what I just described was the plan for the trip. But like with this and just with. We're just like in very rural India and in the Himalayan region, there's just a lot of things that can go wrong. As I. This is a little foreshadowing for later, but there was a lot of flooding in the region. So a lot of it was. We were supposed to camp for a good portion of it, but due to the flooding, all the campsites and stuff were flooded. And like the route we were supposed to take, we weren't able to. So we ended up having to. After we got to the. The airport, where the airport is Shandigar, we drove like a couple of hours a little bit north. But we're still like, we're not really in the Himalayan region yet. We're really still far. We're not at any altitude at this point. So it's still like really hot and sticky and buggy. And we're staying in these kind of like guest home sort of things. They're just, they're hotels, I guess, but I use the word hotel loosely. Like we were still sleeping in our sleeping bags, like, but they had mattresses and stuff. And so that's what we were staying. We ended up having to stay in that first place for five nights because of the flooding that was happening. So at this point in their trip we were doing. We did like three clinics in the town was called Belfast, I think.

Oh, really? That's fine.

No, maybe I made it Billsburg.

Billsburg, yes, yes, that's the one that you. You did not enjoy very much.

No, because it wasn't. There wasn't anything there. And also I had packed for cold weather, as we all did. So we all packed, you know, very like long sleeve stuff. Our clinic clothes were all like we jackets and all this stuff and it was very hot. So that was just a bummer. But I mean, these were the first three days and we really got to kind of like get settled and see exactly what we would be doing on the day to day in clinic.

Okay. Okay. So that was kind of just getting all acclimated to what was going on. Now, okay, you also. You described that there were people from all over, but there were people at people. Because people kept asking me that. They're like, was it just a bunch of med students or were there actual doctors?

Yeah, so there were actual doctors. And then the person who started this whole program, his name is Ravi, and the program's called Himalayan Health Exchange, by the way. And the guy who started it, his name's Ravi, and he is from the Spiti Valley region. So he is from the region and then left, went to the States, and then, like, kind of made this. Did some other stuff, but then, like, ended up making this organization and then to go back and provide health care to this region. But so there was, like, him and who was, like, the organizer of everything, and then, yeah, there was five attendings, one physical therapist, and then there was all of the translators who were also our drivers. And then there was, like, a pharmacist who was also, like a translator from the region.

And then. Were there residents?

Yeah, like, there were. There was one. There was one resident. And then a lot of the foreigners that were, like, about to finish school.

Okay.

Yeah. So.

So you guys were kind of had had the. The lowest level of training.

Yes. Yes. There was a lot of different. It was. It was kind of interesting just because everyone around the world, their school's so different that, like, even though we were all this pretty much the same age, but some people were about to be finished with school because they go straight, like, from high school and stuff. So. But then also, it's just very different. Some of them. They go and they do. Their intern year is kind of like their rotation year anyway. So it's. It's just. It's all just, like, very different.

Yeah. So it's kind of hard to say what level people are. Yeah. Okay. Okay.

But anyway, talking about just more the clinic days, so we had, like, this group of people, and what we would do is Ravi, the organizer, would he. Most of the places had been their places that he's been going back to for, like, it's like 20 almost. It's like 25 years. So it's like a consistent care thing. And they, like, everyone is really receptive to the care just due to the fact that we keep coming back versus other places who will just go in and do it for a couple years and then leave. But Robbie's just been really consistent with bringing people in. So he has these kind of. He has these sites, and since he's from the region. He knows the people. He has ones that have been planned. But since there was the flooding, we ended up having to do some other stuff. He ended up finding us some. Some alternate sites to go to as well. So it was like kind of a mix of ones that had been established and then other ones who. He just kind of like. He just knows people. And. Yeah, so we went to this. This orphanage. It was this boy's home. So, yeah, we saw a lot of kids. And so we would go in and set up. This was set up at a school a lot. We'd set up in some sort of, like, monastery. So it would be like a Buddhist monastery. That was just the space. And, like, we would just go and kind of. We would set up our tables. We would have stations. Each station would be about five or six students and then one attending. And then there was like a PT station as well, and then there was the pharmacy. So a patient would come in and go to triage and give them, like, their. The chief complaint. They take vitals, and then they would walk with their piece of paper over to one of the stations. And then, like, I would. If a patient walked over to our station, one of the people would see them. I would just seep somebody independently and then, like, present to the attending. And. Yeah, so anyway, just talking a lot more about the clinics and, like, what I got to do. So we did these clinics kind of at lower altitude, and then this continued as we went up. And then we would go. We went all the way up to the highest clinic site was at 12,000ft. So we would go up and do these clinics in these different monasteries and see different. It was similar Ish populations in different towns, but kind of the higher we got up, the more. The smaller the patient population would get. And a lot of times the older.

And when you say smaller, you mean fewer people or the people were smaller?

No, no, fewer people. Fewer people. And yeah, there were. And it was a lot of elderly. But I'll talk about more about, like, specifics and, like, things that I saw in a minute, but just talking about more about logistics of, like, what I did and barriers. You know, when I would see a patient, you'd have to have a translator. And we only had like, 10 translators or something. 10 or 15. So it was difficult. And the translators, like, they were trying their best and everything, but their English just wasn't that great. So a lot of it was just. Would get very lost in translation. And it was just. You had to. It was very bare bones, just like, very simple questions of just being like, does your head hurt? Like, do your eyes hurt? Like, very. You know, I would, we'd be sitting there, you know, I'm trying to do a full history. Okay. You know, I see why they came in a bit. It was really. You couldn't ever do any descriptive. I couldn't be like, okay, your stomach hurts. Like, describe how it hurts. That I just never. I tried to ask that question at first and that would just get really confusing. So I stopped asking that cuz it, you know, is it sharp shooting pain? Is it that? Like. No. How'd you kind of skip over that? Really? It was just like, okay, why are you here? When did this start? Which would also sometimes be really difficult. Sometimes I would be like, okay, your stomach hurts. And then I would say, try to tell the translator to ask them, when did this start? And they would come back and say, well, really, like their knee hurts, which was hard. It would end up being a thing where I asked, you know, I talked to, I asked the translator, okay, when, when did this start? And then they go back and forth with the person for like a minute, just back and forth. They're talking, talking, talking, talking. And then it comes back, no, like.

I'm just like, not even the answer to the question.

Yeah, yeah, yeah. And I'm like, so that was the hardest part of everything.

Yeah. I mean, it's hard enough taking a history in your native language without a translator because people do go off on tangents and, you know, and try getting people to try to describe their pain or those things is, Is hard enough. But it's just, it's so important because that's how you figure out a lot of stuff. So trying to just do that in a bare bones way had to be very challenging.

Yeah, no, it was really, it was, it was very challenging. But I mean, I got better at it and especially like at the beginning when I, the first person came in. And also just as a first year, I'm, I am so used to doing a full history and physical, like, I don't, you know, just asking everything. One, because that's how we were taught. But two, because I, I'm still at my level of learning is still that I don't know, the questions ask.

Right.

So it's like, I, you know, it's very, it's minimal. So I, I kind of don't. You know, as a doctor, you should know the questions. And you're like, okay, well, I'm, I'm trying to tailor down my differentials, but I Don't. I don't have really enough knowledge to do that. So it was. It was difficult, but I really just would go, like. It honestly ended up being, okay, what's happening? When did it start? Associated symptoms, and then that's, like. Kind of like it.

That's enough.

Yeah. And then do physical. A lot of it I had to take. I would have to watch the patient as they're talking to the translator and see their body language and what they're doing. I think I learned a lot more from that than the actual translator.

Interesting.

Yeah. Because a lot of times, too, like, there would just be stuff that would get really lost in translation, like, okay, you're having diarrhea. When did that start? I've been having diarrhea for a year. Okay. And then by the time the attending comes over, I mean, that happens anyway, then it's like, oh, no, they don't have any diarrhea. They've never had diarrhea. So, yeah, there was definitely. There was a lot of challenges in that, but. Yeah, but I mean, overall, I think I. I realized I. I really liked the asking questions and trying to figure out what was wrong. Just talking to some of my friends realized that they're like, I don't like primary care at all. I don't like doing that. I want to just be able to do something. Because another frustration was just our limitation. There was kind of only so much that we could do. A lot of it was. Was like, vision, reading glasses, a lot of that sort of stuff, and obviously giving antibiotics when it was appropriate. But a lot of it, it was like, okay, like, you need to go see somebody else. So some of my friends were saying, like, oh, I want to be able to, you know, actually do the thing. But I realized that I, like, I was really enjoying trying to figure it out, the puzzle.

That's a good thing to know about yourself.

Yeah, that's. I really learned that, obviously, I want to. I want to help the problem, but I really liked solving the problem more than I. I think I like actually doing something about it.

Yeah, that's. That's interesting because. Yeah, it seems like the. The people who just really want to cut, they want it all served up to them. You know, tell me what's wrong, and then, you know, show me somebody who has appendicitis and I'll cut it out. But it's more fun to diagnose the appendicitis.

I. I'm more motivated at this point. Also just having a break from the summer, coming back in. I'm More motivated to learn. But it's also, like, when I'm. I'm learning the information, I. I am just, like, more motivated to learn it because I know kind of the thinking pattern to be able to figure out what's wrong. And I know, like, what I need to know.

Yeah.

To figure out what's wrong. Does that make sense?

Yeah, it does make sense. And that's. I think that that's the. That's the really great thing about doing experience like that. Or it's also why med schools are trying to get you guys into the, you know, into the clinic, into the hospital before the end of second year, which, like, wasn't the case for us. But I think it does help because then you're just like, oh, okay, now I know why I need to understand this.

Yeah, for sure.

More motivating to learn it.

Yeah. Yeah. So also realize that I. I did like the sports med. MSK stuff a lot.

Oh, that's good.

That's. There was ultrasound there, so we got to do some of that. And I was like, I really want. I was really trying to gain as much knowledge as I could from that, just because I saw how useful it is. And then also just being there, having even. I learned a lot from the physical therapist, too, of just them being able to kind of, like, look at something and understand, okay, well, we need to do this for this problem and kind of being able to just diagnose from, like, looking and feeling and like, that sort of physical stuff. So that was. I realized that I. I like that it made me want to know more about that stuff so that I can be able to look at a knee and. And do the thing and know that it's an ACL tear, you know?

Yeah. Yeah, it's. And it is that stuff. You know, you can get MRIs. You know, you get an MRI sometimes to. To show the ACL. Well, you really just get that so that the surgeon has a roadmap for repairing it. But diagnosing it you can do on. With history and physical exam. And, you know, and pretty much know that that's the answer. So that's kind of nice.

Talking a little bit more about things that, like pathology that I saw there. There was a couple crazy things, but, I mean, a lot of it, we. Sometimes someone would come in, they just wanted reading glasses. So there was just like, that. Which was. That was a nice thing. We had a lot of reading glasses available, and that was nice to be able to just give somebody something that was going to help them. Same with Eye drops. A lot of them were people who were farmers and worked in the field and had this. Terry gm. Do you know what that is?

No.

So it's this. It's from sun damage, and you have this just growth that comes in, like, starting from the lateral side of your eye and, like, goes medial. And so that was like, so much of that and not really anything you can do. We would just give them sunglasses to prevent more. But I honestly started giving more sunglasses to younger people to try to prevent it because, yeah, nobody wore sunglasses or hats or any of that. And if I saw a healthy eye, which was so rare, like, now my. My standard of a healthy eye is so low that I would see somebody with just like, a tiny bit of Terry Gium and be like, oh, wow, this is a. We got to get them sunglasses because they need to protect their eye.

Wow.

So, yeah.

Sorry. Sidebar. When. When we were hiking in Colorado, we saw this woman putting some goggles on her dog because she was trying to pre dog from getting cataracts. And so they were going for a hike, and she spent, like, the first 20 minutes of the hike struggling with her dog trying to put these goggles on. And we were like, I don't know. I mean, that's nice to do that, but that seems a little bit. Seemed like a little bit much to make your dog wear goggles. But it does make me think that these people probably had a lot of cataracts, too.

Oh, so many. Yeah. I mean, I saw. I remember the first eye that I looked into, it was like, crazy bilateral cataracts. And I was like, whoa, I've never seen it seen like that before. And I was kind of telling people, like, oh, if you, like, want to see some cataracts, look at this patient. And then. But, like, by the end, I was just. I mean, I was so used to seeing it. So, yeah, I mean, lots of that. And again, like, for that, we can't really do anything. We could just tell them, okay, you can go see somebody about that. So, like, that stuff was kind of frustrating. And then, you know, obviously, like, we saw some sick people, like some pneumonia potential. Again, we didn't have any testing to do, so we couldn't figure out exactly what they had. It was just very much where, like, is this viral or is this bacterial? And, like, we just had to do history and physical and try to figure that out and then give antibiotics or don't. That was really what it came down to. So that was a lot. Also a part of the history and physical taking it was like. It was really pared down to. We had to kind of go from what we had and work from that rather than trying to figure out an exact thing. Um, so it was a lot of that, but a couple of more crazy things that I saw. I saw a spinal bifida.

Oh, wow.

In a baby. A full. I don't remember the. Because there's different types, but this was like. It was like a full spinal bifida. Like, it was crazy. Yeah. Hadn't seen that before. And the person didn't even. Like, they were. It wasn't even. It wasn't. The baby wasn't our patient. It was the adult. And then they. She was like, oh, like, do you know what this is on the baby? Pretty much. And then we're like, oh, like, yeah. So that was wild. Another thing that I saw, this was on one of the earlier clinic days, and this was the first time that something, like, kind of emotionally affected me. It was my patient who came in. It was this lady who said that she has migraines, and I was just kind of going through. Talking to her about it. She had had migraines for years. I'm kind of going down the path of being like. Because I don't. I don't really know anything about migraines. Again, I don't really know the questions to ask. I haven't done my neuroblock yet. Like, I don't know. I don't know stuff. So I'm just like, you know, is she sick or is she not? And are we gonna give, you know, are we just gonna treat symptomatically? That's kind of where I was going and, you know, trying to figure out if there's anything else wrong. But then there's some. There was a student from Ireland who kind of was. He's Was older, and he was kind of listening in. As I'm doing my history and physical, I kind of turn around, present to the attending, okay, this lady has migraines. I don't really know what to do. And she was like, oh, okay. Then he was like, well, I've. Can I ask a couple questions? I was like, sure. And then he was like, well, does it hurt when you lean forward? And she was like, yeah. And then he was like, well, is it worse than morning? And she was like, yeah. Are you vomiting? Like, nausea? She was like, yeah. And then I. On physical exam, I, you know, did the basic stuff, but I hate the neuro exam. I hate the physical. The neuro exam. I don't know what I'M doing. I don't know. It's so hard to do it in English, and it is so hard to do it in another language. The peripheral vision test. The thing where essentially, I don't even know how to explain this to our listeners. It's like you cover one eye, and then you put your. The opposite hand in the air, and then you wiggle your fingers, and you're trying to see. You're trying to test if the patient can. Has peripheral vision, is able to see.

Yeah. At what point they can see those fingers wiggling?

Yes. I'm. I. I don't really know how to do it correctly. I did it for my osce, and I. It's so hard to explain in another language. So I stopped doing it, and I didn't do it on this lady. And then he was like, did you do it? And I was like, oh, no. Like, I. I didn't do it. And he was like, okay, well, I'm gonna do it. He does it. But it. I mean, it takes, like, 20 minutes to do because you're working with the translator. She doesn't know what's going on. And then all these other people are trying to do it. And at this point, like, the lady's getting. She came in, when she was talking to me. She was not concerned. She was like, I have migraines, you know, whatever. You know, what's your opinion on this? Kind of just asking for that. She's not really that concerned about the whole thing. Then there's this weird white man wiggling his fingers, and it's forever. Yeah, she's not doing it.

Right.

Whatever. Eventually they get it and they realize that she. She, like, doesn't have purple vision in one eye. And then he's like, okay, well, that's. You know, that's weird. She might have some sort of, like, optic chiasm issue or some sort of, like, tumor, like, pituitary tumor. And, you know, that's what they're thinking. And then we had an ultrasound. So then we start doing an ultrasound on the eye. And again with the translation barrier. Like, she doesn't know what we're saying, what we're talking about. But, like, kind of, like, things are escalating. Now she's going and talking to this other person, having her lay down and do, like, an ultrasound. It's also hard to explain that. And now. And then at this point, she, like, really starts freaking out because she's like, like, what do you mean? Like, I just have a headache. Yeah. Why are you doing an ultrasound on My eye. And then they saw, like, her optic nerve bilaterally. They, like, both were very dilated. So essentially they were like, okay, yeah, she. She has either, like, some sort of chiasm or she has a pituitary tumor. And there's, like, all these people huddled around at this point, and this poor lady is just. Things just escalated so quick, and she, again, doesn't know what's happening. She doesn't speak our language. She doesn't know. She's kind of. She's just. Her face. I could just tell she's just freaking out. She's like, what's going on? What are you saying? Because then all we could translate was like, you need to go to the hospital. And now she's like, okay, well, I just came to you people just because I have a headache, and now you're telling me you need to go to the hospital. Like, what's. What's going on? So that was just kind of. It was just hard to see. And just, like, putting myself in her shoes and being like, I just can't imagine going. You know, everyone around me is speaking a different language. I come in, and now you're telling me, you need to go to the hospital. Like, what's happening?

Yeah. And that whole thing of, like, all of a sudden a bunch of people are looking at me, and everybody's, you know, everybody's crowded around as we're doing this, and. Yeah, that sounds very overwhelming.

Yeah. So I just felt really bad for her. But, I mean, like, at this point, this was when we were at lower elevation, and these people still. It's not like they didn't have any other health care or anything. And there was a hospital nearby, so, like, she could have been able to. You know, I don't know what happened, but she was able to go to the hospital and potentially could have gotten surgery or got a further workup and was able to kind of. Yeah, yeah, could do that. So that was. Well.

And that is, you know, so. Right. That's really good, because she was otherwise just thinking she had to live with this headache. And certainly she could have had a pituitary adenoma that was also causing. Could have been causing some other symptoms that wasn't even aware were being caused by that. And then you can get that thing taken out and just fine.

Yeah. So there's some stuff like that. And then, you know, there's also some stuff that we were like, okay, like, we can't really do anything about this, and we're so far away from anything that, like, there's not really anything that we can do. I think overall, I came in with more of a pessimistic impression of the global health thing. Like, I didn't want to come in and be like, okay, I'm. I'm doing. I'm doing all this great work and saving all these people and, you know, whatever. I'm like, okay, I'm going to learn. But, I mean, we had some doctors there, and people were very receptive to our care. There wasn't any. And I asked Robbie, I was like, does anyone not want to see us? And he was like, no. Everyone loves free stuff. They love. Like, a lot of people would come in as for second opinions and stuff about things from doctors they've already seen. But in other people, this was, you know, they'd never seen a doctor before. And some of it was more maintenance stuff. Some people had seen a doctor and they're like, do you think I should take this blood pressure medicine still? And we're like, yes, take it. You know, so we did. There was. We definitely, like, made impact, and it. That was really cool to see.

Yeah. No, that's good, because that. That's. That is what you worry about, especially when you're coming in as foreigners. You're like, okay, we being respectful and, you know, just. Just all of that. But that's what it makes a big difference, is that Ravi, that he had was from there. So that adds a lot of credibility.

Yeah. And that they like this. They keep coming back every single year. Like, people know that. Yeah.

Yeah. That is huge. I know you. I mean, we've talked about that before about this, you know, this kind of people who, like, oh, yeah, let's go into this country and do some sort of thing, and we're going to save all these people, and then they take off and never come back.

Yeah.

Okay. So you were doing those clinics, and so you kind of kept going further and further up into the Himalayas, right?

Yeah. Yeah.

And at some point, you were up to, like, 12,000ft or something. Is that right?

Our highest clinic site, I think, was at 12,000ft. Yeah. We went up to, like, almost 16,000ft.

Oh, my God. You did?

Yeah.

That's really high.

Yeah. And the roads and stuff was like, the drivers. I mean, now that I've done those drives or, you know, sat in the car for those drives, I'm not afraid of anything. I mean. Yeah, it was like, right. I mean, if there's the cliff right there and, like, it. Yeah. You would not have been able to handle it.

No. And I'm really glad I didn't see you going along. Yeah. I mean, I knew some of it was going to be kind of dicey just because I know how those things go, but. Yeah. Yeah. I mean, even you sent a little video of, like, driving in India with, like, just. Yeah. Animals crossing the street, honking, just going on the other side of the road and just. Yeah, it. It seems very. It's very scary.

Yeah. Houston's nothing compared to that. Definitely. Yeah. Driving in Delhi, it was like driving through a zoo. There's just people and animals. There's just cows and, like, you. There'd randomly be, like, someone just trying to get all of their sheep somewhere and. Yeah.

In the middle of Delhi.

Oh, yeah. Yeah, definitely in Delhi and all over, too. But, yeah, lots of cows. So many cows that you gotta dodge. Yeah. We were joking that it was like Moo Moo Meadows the. In Mario Kart because of all the cows that you would have to dodge. But, yeah.

Wow.

I guess we'll stop there.

In the next part, I want to hear about your diarrhea.

Okay. Next part, we'll talk about my medical issues that went down and then my crazy story about getting back to America. And we'll talk just a little bit more about other specifics or maybe some other questions that people might have about the trip. We have some exciting episodes coming up, so really exciting for that. Really exciting. But in the meantime, you guys know where to find us @Generations MD on Instagram and Tick Tock. And if you have any questions or interested in being a guest on the podcast, you can email us at ask generations.mdgmail.com and we will talk to you next week. Bye, guys. Bye, guys.