hola, or namaste, friends
i write you now from delhi, where good home cooked food, company of my family, and hot water and comfortable climate abounds.
after the palace stay, we rode camels in the sand dunes and stayed in a tent overnight! desert people are a very interesting species. And I have now stayed in my second tent ever with a sink and western toilet. it is still very weird to me. I took millions of pictures of camels and desert and will post when I get home!
carla and i continue to shop our little hearts out. tomorrow we will see the taj mahal and some more of agra... i feel so fortunate to have seen the taj twice already in my lifetime, as everytime I go I am more depressed about the condition in which it is (not) maintained. Hurry friends, as there is no picture or words that can describe this feat--but it is incredible to see, and so is the story behind it. I am so happy carla will get to see it tomorrow.
also, carla bought a beeeeeeeeeeeautiful sari that is a perfect color on her, now she just has to learn to wear it...
well, thats all for now,
See you all soon!
Sunday, February 25, 2007
Thursday, February 22, 2007
Elephants, monkeys, and camels, oh my!
so now i am sitting at the jodhpur train station. i forgot to mention in my last post that in goa we also went to carnival. Of note, it is apparently okay for the men to dress in drag that day--and I'm talking about all out. While I think it is wonderful to see women in sari's and langa's and all other traditional wear, it is very disturbing to see men in sari's, high heals, cheerleader outfits (don't worry, i have photos). I loved the carnival, the whole town was out, there weren't peddlers, everyone was just celebrating loving Goa. Everyone was really nice, it was totally safe, and just warm and fuzzy. I really liked that alot of the floats were about protecting goa: like "don't level off our beautiful hills to make cities" and the float that had a GIANT ribbiting frog that said, "save the frogs, they kill mosquitos" and the front of the float had a fake dead dengue fever patient on it with a fake mosquito on top of him that was the size of a human. Another float that rocked was one that said "we are one" and had the christian, muslim, and hindu symbols on it and alot of dancing people of all different faiths. Goa was very clean, progressive, and yet still deeply cultural. I loved it. Also, carla and I got to hang out with a baby elephant in the water (during our visit to the spice plantation). It was pretty cool. Pictures to come.
So last night, after yet more delayed flights, we stayed in a palace--it is called the Balsamand Lake Palace, in case you want to look it up. IT WAS AMAZING. The regal suite was huge, there were two huge bathrooms with tons of hot water, a bathtub, and waterfall showerhead. There were huge arches or carved sandstone and stained glass. The entire castle was made out of marble and sandstone--all hand carved. We also ate at their fancy restaurant for dinner and breakfast. We had cocktails on the terrace last night, and this morning we watched a playful group of monkeys wreak havoc! It was great. We then walked around the gardens, I stared at the horses, and people kept giving us flowers. I also saw an all marble swimming pool. We had great conversations with two older couples that have travelled the world and are now writing--one couple is making a coffee table book, and the other is writing their own respective life stories. Too cool! I can only hope that's what I get to do when I'm old. Travel and write (and maybe take some pictures). Well, they tipped us off, that we have to see the fort, so after leaving our bags at the palace and trading in our last train ticket for a plane ticket (after the palace, we decided one overnight train--tonight's train to jaisalmer--would be enough--I know, I'm a bit spoiled now)--we went to the fort. It was probably, the largest structure I have ever seen, and there were entire rooms made out of gold and marble and ivory. Also, I think carla and I have gotten a bit too good at haggling--apparently, we are getting cheaper rickshaw rides than some of the indian people and lonely planet's map of this town is awful! Also, here in north india, I am getting to use my hindi (while my cousins aren't around to laugh at my accent and mispronounced words). I think people really appreciate it (except for those that don't expect me to speak hindi, and then realize I do when they were talking about carla and I like we weren't there...) Anyways, its pretty nice to understand whats going on. Sometimes when I speak though, Spanish just flows out. I think I really confused a few shop owners when I was saying "Si, como no." So it goes.
Carla and I also did some fun shopping!!! I love the things that I have gotten for me and a few others, but I might be eating cream of wheat for a few weeks when I get back to stay on budget. (Don't worry mom and dad, I'm not doing toooooo much damage.) I guess I'm just worried that I will have to put life on hold for the next six years during residency and fellowship--ie travelling life. So all the stuff I saw in India last time and didn't buy, I'm working haggling skills to pick up some of it.
Anyway, we are going to take an overnight train in a few hours to jaisalmer for our camel safari. I saw a few camels here in Jodhpur, and I never realized that they are HUGE!!! They are literally about twice the height of a normal horseI really hope I don't fall off one.
Also, Ravi, this one is for you: remember that book about Grandma Tildy "But No Elephant." Carla has been shopping for a bedspread, and her only really specific request is that there are no elephants on it (popular item for bedspreads here in india). Everytime she wags her finger no at an elephant, I think of that book and you!
Missing all of you very, very much. This time next week, I'll already be heading home!
So last night, after yet more delayed flights, we stayed in a palace--it is called the Balsamand Lake Palace, in case you want to look it up. IT WAS AMAZING. The regal suite was huge, there were two huge bathrooms with tons of hot water, a bathtub, and waterfall showerhead. There were huge arches or carved sandstone and stained glass. The entire castle was made out of marble and sandstone--all hand carved. We also ate at their fancy restaurant for dinner and breakfast. We had cocktails on the terrace last night, and this morning we watched a playful group of monkeys wreak havoc! It was great. We then walked around the gardens, I stared at the horses, and people kept giving us flowers. I also saw an all marble swimming pool. We had great conversations with two older couples that have travelled the world and are now writing--one couple is making a coffee table book, and the other is writing their own respective life stories. Too cool! I can only hope that's what I get to do when I'm old. Travel and write (and maybe take some pictures). Well, they tipped us off, that we have to see the fort, so after leaving our bags at the palace and trading in our last train ticket for a plane ticket (after the palace, we decided one overnight train--tonight's train to jaisalmer--would be enough--I know, I'm a bit spoiled now)--we went to the fort. It was probably, the largest structure I have ever seen, and there were entire rooms made out of gold and marble and ivory. Also, I think carla and I have gotten a bit too good at haggling--apparently, we are getting cheaper rickshaw rides than some of the indian people and lonely planet's map of this town is awful! Also, here in north india, I am getting to use my hindi (while my cousins aren't around to laugh at my accent and mispronounced words). I think people really appreciate it (except for those that don't expect me to speak hindi, and then realize I do when they were talking about carla and I like we weren't there...) Anyways, its pretty nice to understand whats going on. Sometimes when I speak though, Spanish just flows out. I think I really confused a few shop owners when I was saying "Si, como no." So it goes.
Carla and I also did some fun shopping!!! I love the things that I have gotten for me and a few others, but I might be eating cream of wheat for a few weeks when I get back to stay on budget. (Don't worry mom and dad, I'm not doing toooooo much damage.) I guess I'm just worried that I will have to put life on hold for the next six years during residency and fellowship--ie travelling life. So all the stuff I saw in India last time and didn't buy, I'm working haggling skills to pick up some of it.
Anyway, we are going to take an overnight train in a few hours to jaisalmer for our camel safari. I saw a few camels here in Jodhpur, and I never realized that they are HUGE!!! They are literally about twice the height of a normal horseI really hope I don't fall off one.
Also, Ravi, this one is for you: remember that book about Grandma Tildy "But No Elephant." Carla has been shopping for a bedspread, and her only really specific request is that there are no elephants on it (popular item for bedspreads here in india). Everytime she wags her finger no at an elephant, I think of that book and you!
Missing all of you very, very much. This time next week, I'll already be heading home!
Tuesday, February 20, 2007
brief update
so we made it goa (don't ask about the journey, lets just say, it was on india standard time). and then they put us in a tent for the first night) and not the Air conditioned suite they confirmed and charged me for--but i have to say, it is the first ever air conditioned tent i have ever seen; it also had a western toilet, a sink, and hot and cold running water from an actual shower head. there was also two beds and a desk and a porch. it was the weirdest thing ever. also, when i was trying to argue with the hotel staff to give me a suite, it was difficult cause the conversation went like this.
"I did not pay good money to live in a tent, i want comfort, i want air conditioner"
"Don't worry madame, there is an airconditioner"
"in the tent?"
"Yes yes in the tent"
"well i want a hot shower"
"no problem madame hot and cold running water in the tent"
"i don't want to take another bucket shower"
"no problem madam there is a shower head"
this went on and on about the toilet, sink, and then shortly after arriving at the tent (goa was fully booked, and we got the suite the next day)--we got room service, to our tent. don't worry, carla and i have pictures of the air conditioned tent.
But aside from all that--Goa was amazing. We were in south goa with old people (which was fine with me cause i'm not quite ready for swimsuit season and old european men in speedos and women in g strings make me feel ALOT better about myself). It was quite and there were vast stretches of beach without anyone around. It's nice there because they don't build on the water front, so no big hotels to spoil the view, they are all set back and hidden by palm trees, only beach shacks with food and drinks and souvenirs are around. Also, I got to split a king crab with carla. The crab was twice the size of my head. I'm not joking. And I have never been full just eating crab before. Those of you that know my fettish for snowcrabs (jon, remember the 5 plates of snow crab legs for my birthday?) really understand how much that crab meant to me. But I started to worry about my karma afterwords, cause they were crabs all of the beach, and with the damage I did, I was expecting something in return.
We also visited a spice plantation, and amanda, i could not stop thinking about you! They greeted us with a garland of flowers, a shower of flower petals, two cups of herbal tea and snacks. Then I learned all sorts of cool stuff. I also tried fresh cinnamon (literally, he scrapped the bark off the tree and handed it to me), i learned that both bamboo and banana trees are actually in the grass family. And all sorts of other stuff I have already basically forgotten. Oh! and i saw how cashews grow! They have this fruit attached that they call the cashew apple, and the cashew hangs from the fruit in a shell. So obviously, you eat the cashew, they make poisons from the shell (apparently it's got some evil stuff), and from the fruit, you make... FENI!!! This is a very smooth alcohol my friends, which I had never heard about before. What a great plant--so many uses.
Well now I am sitting in the Mumbai airport writing this on my way to Johdpur where carla and I will be staying in a palace. Travel days rarely go well for us--already one delayed flight. But I'll keep you posted.
"I did not pay good money to live in a tent, i want comfort, i want air conditioner"
"Don't worry madame, there is an airconditioner"
"in the tent?"
"Yes yes in the tent"
"well i want a hot shower"
"no problem madame hot and cold running water in the tent"
"i don't want to take another bucket shower"
"no problem madam there is a shower head"
this went on and on about the toilet, sink, and then shortly after arriving at the tent (goa was fully booked, and we got the suite the next day)--we got room service, to our tent. don't worry, carla and i have pictures of the air conditioned tent.
But aside from all that--Goa was amazing. We were in south goa with old people (which was fine with me cause i'm not quite ready for swimsuit season and old european men in speedos and women in g strings make me feel ALOT better about myself). It was quite and there were vast stretches of beach without anyone around. It's nice there because they don't build on the water front, so no big hotels to spoil the view, they are all set back and hidden by palm trees, only beach shacks with food and drinks and souvenirs are around. Also, I got to split a king crab with carla. The crab was twice the size of my head. I'm not joking. And I have never been full just eating crab before. Those of you that know my fettish for snowcrabs (jon, remember the 5 plates of snow crab legs for my birthday?) really understand how much that crab meant to me. But I started to worry about my karma afterwords, cause they were crabs all of the beach, and with the damage I did, I was expecting something in return.
We also visited a spice plantation, and amanda, i could not stop thinking about you! They greeted us with a garland of flowers, a shower of flower petals, two cups of herbal tea and snacks. Then I learned all sorts of cool stuff. I also tried fresh cinnamon (literally, he scrapped the bark off the tree and handed it to me), i learned that both bamboo and banana trees are actually in the grass family. And all sorts of other stuff I have already basically forgotten. Oh! and i saw how cashews grow! They have this fruit attached that they call the cashew apple, and the cashew hangs from the fruit in a shell. So obviously, you eat the cashew, they make poisons from the shell (apparently it's got some evil stuff), and from the fruit, you make... FENI!!! This is a very smooth alcohol my friends, which I had never heard about before. What a great plant--so many uses.
Well now I am sitting in the Mumbai airport writing this on my way to Johdpur where carla and I will be staying in a palace. Travel days rarely go well for us--already one delayed flight. But I'll keep you posted.
Friday, February 16, 2007
Last day in Vellore
So yesterday, I went to a special hospital where I thought we were going to see leprosy outreach programs, but I didn't see any leprosy patients at all! Apparently, the scope has expanded to um, just about everything, and even though I didn't get to see leprosy like I did at CHAD, i did get to see lots of everything else! In four hours of clinic, here is a glimpse of what came through the door:
A homeless man with Parkinson's Disease
Two children with Scabies
Two working adults with Fungal Skin infections (hands of a clothes washer, and abdomen of a diabetic man)
Rheumatic Heart Disease (loudest mitral murmur I've heard to date) in a young mom
Uterine Prolapse in an elderly woman (she had 6 kids)
Vitiligo from vitamin deficiency in a young boy
The differential for a child with tummy pain #1 is worm infestation here! (hookworms enter through the feet, and everyone here is barefoot!)
Pulmonary TB
Discoid Eczema
Then in the afternoon, I went to Infectious Disease Clinic, where I saw patients with pulmonary TB, extrapulmonary TB (those are some scary looking lesions), HIV, or both. I learned alot about the government programs for those epidemics here. First, and most angering, the most common new diagnosis of HIV is in women that got it from their husbands who had extramarital affairs or homosexual relationships. One man was diagnosed last august and was taking medications, but did not tell his wife or bring her in for treatment until yesterday (he's crusin' for a bruisin'-- he's lucky he's not my patient or he never would have heard the end of it, thats all I have to say) and apparently, it is not all that uncommon. For the past two years, the government has provided HIV and TB therapy for free across the nation. They use directly observed therapy with pretty good compliance results. A community member, that is not a relative, observes them take TB medications everyother day and keeps a record that the patient brings in for visits. And when therapy is started, the entire 6 months of medications are given so there is no shortage or break in therapy! Just like everywhere else in the world, there is much stigma and ostricizing of those with HIV.
The doctors were excellent teachers yesterday, the outreach clinic doctor was a real talker. He also explained local politics and customs in Tamil Nadu. For example, the politica parties here, basically rotate every five years. During election time, the party comes through and pours out tons of free alcohol, which many people would never be able to afford normally, and gets everyone drunk to vote for them. They also buy votes, apparently, a vote is going for about 2,000 rupees, which if you read my previous post, can be about a years salary for some of these folks....*Sigh*
There are also many local traditions, one of the villages that we were in was going to have a function for a goddess of the town, where they WALK ON FIRE/hot coals to appease her/keep her happy. the other village, they grow children's hair out, boys and girls, and cut it off when it is long as an offering to the goddess. Lets just say im glad im not going back to that clinic AFTER the fire walking.
So yesterday daytime was fun, then Carla and I went to eat at our favorite restaurant in town for our last dinner and pigged out big time--our own dishes, lassi's, and sundaes.
So tonight we are off to Banglore to catch a flight to Goa in the morning.
I think that now that I have had a small glimpse of the health and poverty in India, I will never look at it the same. The difference between rich and poor here is... I mean a party being able to pay each man a year's wages for a vote?
I am so thankful for being blessed in this life and for the opportunity to see what is being done for those less fortunate, and perhaps one day soon, to also try and make a difference.
A homeless man with Parkinson's Disease
Two children with Scabies
Two working adults with Fungal Skin infections (hands of a clothes washer, and abdomen of a diabetic man)
Rheumatic Heart Disease (loudest mitral murmur I've heard to date) in a young mom
Uterine Prolapse in an elderly woman (she had 6 kids)
Vitiligo from vitamin deficiency in a young boy
The differential for a child with tummy pain #1 is worm infestation here! (hookworms enter through the feet, and everyone here is barefoot!)
Pulmonary TB
Discoid Eczema
Then in the afternoon, I went to Infectious Disease Clinic, where I saw patients with pulmonary TB, extrapulmonary TB (those are some scary looking lesions), HIV, or both. I learned alot about the government programs for those epidemics here. First, and most angering, the most common new diagnosis of HIV is in women that got it from their husbands who had extramarital affairs or homosexual relationships. One man was diagnosed last august and was taking medications, but did not tell his wife or bring her in for treatment until yesterday (he's crusin' for a bruisin'-- he's lucky he's not my patient or he never would have heard the end of it, thats all I have to say) and apparently, it is not all that uncommon. For the past two years, the government has provided HIV and TB therapy for free across the nation. They use directly observed therapy with pretty good compliance results. A community member, that is not a relative, observes them take TB medications everyother day and keeps a record that the patient brings in for visits. And when therapy is started, the entire 6 months of medications are given so there is no shortage or break in therapy! Just like everywhere else in the world, there is much stigma and ostricizing of those with HIV.
The doctors were excellent teachers yesterday, the outreach clinic doctor was a real talker. He also explained local politics and customs in Tamil Nadu. For example, the politica parties here, basically rotate every five years. During election time, the party comes through and pours out tons of free alcohol, which many people would never be able to afford normally, and gets everyone drunk to vote for them. They also buy votes, apparently, a vote is going for about 2,000 rupees, which if you read my previous post, can be about a years salary for some of these folks....*Sigh*
There are also many local traditions, one of the villages that we were in was going to have a function for a goddess of the town, where they WALK ON FIRE/hot coals to appease her/keep her happy. the other village, they grow children's hair out, boys and girls, and cut it off when it is long as an offering to the goddess. Lets just say im glad im not going back to that clinic AFTER the fire walking.
So yesterday daytime was fun, then Carla and I went to eat at our favorite restaurant in town for our last dinner and pigged out big time--our own dishes, lassi's, and sundaes.
So tonight we are off to Banglore to catch a flight to Goa in the morning.
I think that now that I have had a small glimpse of the health and poverty in India, I will never look at it the same. The difference between rich and poor here is... I mean a party being able to pay each man a year's wages for a vote?
I am so thankful for being blessed in this life and for the opportunity to see what is being done for those less fortunate, and perhaps one day soon, to also try and make a difference.
Tuesday, February 13, 2007
RUHSA
stands for Rural Unit for Health and Social Affairs.
That is where I have spent the last two days.
So I think I figured out what fourth year of medical school is for... besides applications, and interviewing, and long long bouts of painful waiting for some one to hand down the verdict on the next three years of your life and what not. I think it is a time to just chill out for a second, stop the craziness, and slow down the pace... to the point where you are just bursting at the seams to actually get to the next step. That has all been exacerbated here in India. You see, for visa purposes and what not, we are observers--sometimes we listen to a finding or do a minor exam--but after learning to take care of patients, it is soooooooooo hard to just watch! The gift that is given to a medical student, is that you take care of the patient. You do a full history, and physical, and you take time to read about what can help your patient, and you talk to the family, and you ask questions to those that more than you and you just get to take it all in--I don't think I fully realized the implications of all this, till now, when I have to sit back and watch! Well I guess it's a good thing I'm aching for some clinical work, cause I hear motivation through intern year is a neccessity.
I think it has also been difficult to just be an observer due to the sheer number of patients that we have seen in a short time. I mean, this could be medical student heaven (and intern hell) with the number and variety of patients you can chose to follow. Yesterday, in one hour, 54 patients walked through the mobile clinic. And then today, in about 20 minutes, 30 pregnant woman received check ups. In the US, I have only rarely seen a doctor see 30 clinic patients in one day--but that was over a WHOLE day, not 20 minutes. In this amount of time, the baby's heart beat was heard, mother's blood pressure was taken, size and dates were estimated, position of the baby was estimated, anemia was screened for (stick your tongue out), and vitamin and folate supplements were given. This was achieved with one doctor, one nurse, and one health aid. It was just crazy.
I am surprised at the amount of obesity, hypertension, and diabetes that I am seeing! And some of the patients are still vitamin deficient. I wonder if it has always been there and is being documented and treated now? I mean, this is not the city, there is not fast food, many of these families have very poor diets. This is rural villages. Also there is a huge number of seizure disorders here. Yesterday I asked the intern what the etiology was... birth asphyxia or trauma? no, most of it is post infectious-after meningitis. There is alot of it. Lets just say I'm glad I had that vaccine.
And then Carla had a very interesting run in in clinic with MEASLES! Crazy?!?! Not everyone here is vaccinated, and the doctor freaked out and asked if Carla had her vaccination since she was near the patient, because THE DOCTOR DID NOT HAVE THE VACCINATION! I mean, really--educated, adult person in the field of medicine in India. I guess I'm just silly, but I thought at least measles was routinely vaccinated against.
Today we also got to see some of the socioeconomic devel0pment programs that are run through the program. We saw people making brooms (not the kind in America, the ones everyone in India uses), incense (2000 sticks per day per person), and dried coconut leaf weaving (used to cover thatched huts and what not). These folks spend alot of their day doing this and make an average of 20 rupees a day (that equals 50 cents).
I got some great pictures again today, but you are going to have to wait till I get back. I am just too impatient with the slow connections and lack of USB ports here. This is something else carla and I have been discussing--don't we outsource our computer stuff to India? Isn't there a major software industry here? All the connections are slow and computer's old. I ran into the director of pediatrics the other day, and he was taking a seminar on biostatistic's computer modelling. He said he really wanted the software, but his department couldn't afford it. So I guess there you have it. It is produced here in India, and yet a private hospital department can't afford it. We export our fatness through fast food. They export their genius, textiles, hand crafts.
Well, one of the other things that I am thankful for and very aware of while here--is that I am American. I am proud to have a culture and ethnicity so beautiful, but I just think how different my life would have been as a female in India--whatever social class. I can't even imagine me being me.
I think that is about it for now, tomorrow I might go wander around the ER. I'll keep you posted;)
That is where I have spent the last two days.
So I think I figured out what fourth year of medical school is for... besides applications, and interviewing, and long long bouts of painful waiting for some one to hand down the verdict on the next three years of your life and what not. I think it is a time to just chill out for a second, stop the craziness, and slow down the pace... to the point where you are just bursting at the seams to actually get to the next step. That has all been exacerbated here in India. You see, for visa purposes and what not, we are observers--sometimes we listen to a finding or do a minor exam--but after learning to take care of patients, it is soooooooooo hard to just watch! The gift that is given to a medical student, is that you take care of the patient. You do a full history, and physical, and you take time to read about what can help your patient, and you talk to the family, and you ask questions to those that more than you and you just get to take it all in--I don't think I fully realized the implications of all this, till now, when I have to sit back and watch! Well I guess it's a good thing I'm aching for some clinical work, cause I hear motivation through intern year is a neccessity.
I think it has also been difficult to just be an observer due to the sheer number of patients that we have seen in a short time. I mean, this could be medical student heaven (and intern hell) with the number and variety of patients you can chose to follow. Yesterday, in one hour, 54 patients walked through the mobile clinic. And then today, in about 20 minutes, 30 pregnant woman received check ups. In the US, I have only rarely seen a doctor see 30 clinic patients in one day--but that was over a WHOLE day, not 20 minutes. In this amount of time, the baby's heart beat was heard, mother's blood pressure was taken, size and dates were estimated, position of the baby was estimated, anemia was screened for (stick your tongue out), and vitamin and folate supplements were given. This was achieved with one doctor, one nurse, and one health aid. It was just crazy.
I am surprised at the amount of obesity, hypertension, and diabetes that I am seeing! And some of the patients are still vitamin deficient. I wonder if it has always been there and is being documented and treated now? I mean, this is not the city, there is not fast food, many of these families have very poor diets. This is rural villages. Also there is a huge number of seizure disorders here. Yesterday I asked the intern what the etiology was... birth asphyxia or trauma? no, most of it is post infectious-after meningitis. There is alot of it. Lets just say I'm glad I had that vaccine.
And then Carla had a very interesting run in in clinic with MEASLES! Crazy?!?! Not everyone here is vaccinated, and the doctor freaked out and asked if Carla had her vaccination since she was near the patient, because THE DOCTOR DID NOT HAVE THE VACCINATION! I mean, really--educated, adult person in the field of medicine in India. I guess I'm just silly, but I thought at least measles was routinely vaccinated against.
Today we also got to see some of the socioeconomic devel0pment programs that are run through the program. We saw people making brooms (not the kind in America, the ones everyone in India uses), incense (2000 sticks per day per person), and dried coconut leaf weaving (used to cover thatched huts and what not). These folks spend alot of their day doing this and make an average of 20 rupees a day (that equals 50 cents).
I got some great pictures again today, but you are going to have to wait till I get back. I am just too impatient with the slow connections and lack of USB ports here. This is something else carla and I have been discussing--don't we outsource our computer stuff to India? Isn't there a major software industry here? All the connections are slow and computer's old. I ran into the director of pediatrics the other day, and he was taking a seminar on biostatistic's computer modelling. He said he really wanted the software, but his department couldn't afford it. So I guess there you have it. It is produced here in India, and yet a private hospital department can't afford it. We export our fatness through fast food. They export their genius, textiles, hand crafts.
Well, one of the other things that I am thankful for and very aware of while here--is that I am American. I am proud to have a culture and ethnicity so beautiful, but I just think how different my life would have been as a female in India--whatever social class. I can't even imagine me being me.
I think that is about it for now, tomorrow I might go wander around the ER. I'll keep you posted;)
Saturday, February 10, 2007
lazzzzzzzzzzy weekend
so after last weekends excursion to pondicherry, carla and i decided to spend a chill one here in vellore. and i also wanted to go see the leprosy clinic which is Saturday mornings. so it worked out well. I learned alot in a very short amount of time. Leprosy is scary and sad. That's all I have to say about that.
we have heard about this "pool" here that is apparently exclusive and the coolest thing to do on weekends, but yesterday it was not sunny! for the first time since we've been here! but hopefully we will have better luck today. Also, heros came on TV last night, and its pretty good.
Other than that, we are just sleeping and eating and relaxing. Next week, we are at the rural health care center about an hour away and then we are going to a leprosy village, where people that were turned out of their community because of their deformities, live. And then on Friday night we are off to Goa for their annual carnival! We also heard about a place where you can bathe elephants and climb waterfalls, so now carla and i are super excited. between the camels and elephants, i am jumping up and down like a three year old:)
so nothing much going on over here this weekend; missing everyone over there lots.
we have heard about this "pool" here that is apparently exclusive and the coolest thing to do on weekends, but yesterday it was not sunny! for the first time since we've been here! but hopefully we will have better luck today. Also, heros came on TV last night, and its pretty good.
Other than that, we are just sleeping and eating and relaxing. Next week, we are at the rural health care center about an hour away and then we are going to a leprosy village, where people that were turned out of their community because of their deformities, live. And then on Friday night we are off to Goa for their annual carnival! We also heard about a place where you can bathe elephants and climb waterfalls, so now carla and i are super excited. between the camels and elephants, i am jumping up and down like a three year old:)
so nothing much going on over here this weekend; missing everyone over there lots.
Friday, February 9, 2007
I can't believe that I won't have ice in my drinks for another couple weeks.
What do we do when it gets hot over there in Texas? perhaps some sweet tea or lemonade? but one thing is for sure--whatever beverage it is, it has ice in it. It's weird to think that it will be weeks before I get ice in my drinks again. oh well, im sure when i get back, i will go through withdrawal from naan and mango lassi's. So it goes.
I have had an amazing few days. I had the opportunity to go on home visits in some of the many villages here in Tamil Nadu (the state that I am in). I feel that one of the blessings of being in the world of health care is the intimate nature of the work. And truly, sharing someone's home, their space, for even a few moments, is such a gift. So on wednesday morning, armed with a packed south indian lunch, a bottle of water, my stethescope, and my (of course) camera, i jumped into my non-ac jeep with a driver, a nurse, nursing student, and another medical student and off we went. Looking out the window, slowing the traffic dwindled, then the roads became a bit rougher ride, then the asphalt altogether disappeared, monkeys began to appear on the dirt path and swinging from trees. The jeep came to a halt, and for the first time since I left Honduras five years ago--it was that silence--that you get in a rural village, removed several times over. It's not a true silence, but it is where you are suddenly keenly aware of every sound, without even trying. You both feel, and hear a gentle breeze. If there is moving water near by, even just a trickle, it is the loudest sound around. You walk by a cow eating, and you actually here him chewing. The sound of your own footsteps and those with you, sound like a jet engine in comparison to your surroundings. It is absolutely beautiful. And the colors magnificent. Sometimes I wonder if, just like your sense of hearing seems heightened, whether the same thing happens with vision, when you aren't bombarded by manufactured advertising competing for your attention. I have some great photographs, but you are going to have to wait till I get back to the States to see them. Anything less than downloading them at full capacity just isn't fair to the beautiful people and landscape that i was privledged to experience. The peace that comes over you is almost intoxicating.
The beauty of human beings when they are not self conscious. I believe that in the West, from a very young age, we are taught to be self conscious. Not that its a bad thing--but when we are taught manners, how to eat, how to introduce ourselves... we are really building up self conciousness (in my opinion). I forget that-- until I am around people that are not self conscious. Their movements are beautiful, natural. It's hard to describe--adults and children alike, when they are wholly unconcerned by your perception of them. The way they sit, walk, use their hands, even just something as simple as the way they look at you. It is so simple and yet so intense after being so many steps removed from it.
When you are out and about in India, if you are from the West, you will be stuck by the litter, the cow dung, the filth that covers the streets and all public spaces. What most visitors never see, are the inside of a dwelling besides perhaps a hotels, restaurants, or shops. Every hut, big or small, or larger house--was immaculate. Even if the floor was unpaved, it was clean. I just want to point out, that there is a VAST difference in the way public and private space is viewed. The wealthiest and the poorest here will litter freely. But both will also keep their own houses clean. I find that really interesting--I think understanding why will be the key to cleaning up india--not just for aesthetics, but also for the sake of public health.
Let's talk about customs. It is an Indian custom to remove your chappals (indian word for flip flops) or shoes before entering a persons house. So I did this everytime I entered a house, big of small, dirt floor or marble floor. And, for unknown reasons, I really enjoy it! Another custom, it is as if indian people are really really uncomfortable with standing humans. Even if you are there for 2 seconds, you will be repeated asked to sit if you are standing. I think it just comes from the incredible hospitality. And rich or poor, they will all offer you something to eat or drink, even if it is the last of what they have if you are a new visitor. It makes my heart hurt with the sweetness of it all. Wednesday, is also some type of holy day that I haven't quite figured out. But just about everyday, most women in the city, and all in the villages, adorn their hair with beautiful, bright, fragrant flowers--but on wednesday, from what i gather is for religious reasons, everything is adorned even more. Everywhere I went, people kept putting flowers in my hair. One woman, after frustration with flowers falling out of my hair repeatedly, went and got one of her own bobbypins to secure her gift to me in my hair! In front of all of the houses, there is artwork on the ground at the enterance. Some of it is amazingly intricate (pictures coming). And some remake the design everymorning! The other student that was with me kept asking about adornments, and these house markings, for the reasons behind them. The nurses often just replied--because its beautiful, its for aesthetics. Beyond that, I would go so far to say that color is a custom here. From the clothes drying on the lines, bangles adorning even the infant females, flowers in the hair, and so on--the brilliance and intensity of color is striking. I was thinking it would be a fun experiment to give a western kiddo and an indian kiddo the same coloring book and box of crayons and see the differences that result!
I just want to talk a little about CHAD--the community health and development hospital that i was working at this week, so that you understand how the home visits fit into the vision. I had an amazing time talking to a Mr. Ranjeet this morning. He is the coordinator for visitors to CHAD and also one of the most informative people I met about the program. We talked about the two goals--interwined but inherently different entitites--health and socioeconomics. He started the discussion by pointing out that the poor will only spend money on health, or make it a priority, when there is some money above and beyond what is needed for food, water and shelter. That is why there is a socioeconomic component to the program. Sure, maybe if no one is sick, they spend extra money on a luxury or comfort--right now the fad is a color TV--which the people here can afford that they couldn't ten years ago. Odd as it seems to see a huge color tv in an unpaved, thatched roof hut--he points out that it makes a great bartering tool if someone falls sick and requires hospitalization. It just struck me as so sad. Very few would disagree that health should be considered a basic human right. But when you get down to the poorest of the poor, and you have to pick out necessity--it is more important to eat than have good health. Thats just a fact. So to give them some more income--they developed programs such as a daycare called a balwadi--where kids can go before they reach school age--and with that you create two income families. Tamil Nadu has declared that there should be a balwadi every two kilometers, in all inhabited areas, so no mother has to travel further than that to have subsidized child care. These daycares are subsidized by the government, there is supervision, education, and meals provided. They also give a protein and vitamin nutritional supplement. A doctor visits once a month to do well child check ups and the nurses monitor the weights of the children and classify level of malnutrition. It's brilliant. The economic development programs target women, mostly because agriculture is hard work, but profitable--so they don't want men to take up other skills. Interesting.
Mr. Ranjeet also said that this has all had unexpected consequences. The structure of the family ten years ago was a combined family. Parents would have children, the males would marry, daughter in laws would move in and have children, real daughters would be married off to go live in their in laws house. The son's would work, bring back the money and give it to the elder to then take care of finances. Well, when women started working, they didn't like the idea of giving money to some old guy that wasn't their real dad, that might get spent on the new kid of another brother's wife instead of her kid. So she turns to her husband and says, with our two incomes lets move out. Boom. In less than ten years now nuclear families predominate. So whats the big deal you might say? The combined family provided a forum for disputes between husband and wife. It provided community for kids and wives to talk to people other than direct siblings or husbands. Divorce has skyrocketed. Adolescents, without someone to vent to, and the elderly, without sons to maintain their houses--are committing suicides at astronomical rates. I was speechless (and you all know that is a rare event).
What did I see in the village?
I saw an elderly man, whose ear was swollen to the size of an orange. It was infected secondarily after a suicide attempt of pouring hot oil over himself and scalding off half his skin. He won't go to the hospital because he still wants to die, and hope the infection kills him. I saw a woman whose husband was killed when a bull gored him at a festival where they get the bulls drunk and wrestle them. She has a one and a half year old daughter. She will probably be kicked out of her in laws house since she did not have a son, and a granddaughter is just added expense. She is not allowed to wear bangles, or adorn her hair with flowers, or wear bright colors now that she is a widow--making her the lowest of the low. There was a nuclear family of four where the father had died (I don't remember how). The mother was unskilled, so she sent her son away to a factory to work for some months to make money to support her, his siblings, and a 7 year old cousin that was orphaned because his parents died of AIDS. He has HIV. The son that went away to work? He is 10. There was more. Suffice it to say, there was so much inner turmoil and unrest in this outwardly peaceful environment. Amongst all this, people were all smiling and hopeful. Gracious and open.
I love the children. I love that they are being taken care of by CMC, the government, their families. I love that in these new day cares, they know their days of the week, alphabet, numbers, in tamil and in english, by the age of three. I love that their mothers are learning skills and investing in them. I love the hope.
sorry this blog was so disjointed. it will probably be awhile before i am able to put it all together so I just figured i'd put it out there as it is to me now. Ambivalence abounds.
I have had an amazing few days. I had the opportunity to go on home visits in some of the many villages here in Tamil Nadu (the state that I am in). I feel that one of the blessings of being in the world of health care is the intimate nature of the work. And truly, sharing someone's home, their space, for even a few moments, is such a gift. So on wednesday morning, armed with a packed south indian lunch, a bottle of water, my stethescope, and my (of course) camera, i jumped into my non-ac jeep with a driver, a nurse, nursing student, and another medical student and off we went. Looking out the window, slowing the traffic dwindled, then the roads became a bit rougher ride, then the asphalt altogether disappeared, monkeys began to appear on the dirt path and swinging from trees. The jeep came to a halt, and for the first time since I left Honduras five years ago--it was that silence--that you get in a rural village, removed several times over. It's not a true silence, but it is where you are suddenly keenly aware of every sound, without even trying. You both feel, and hear a gentle breeze. If there is moving water near by, even just a trickle, it is the loudest sound around. You walk by a cow eating, and you actually here him chewing. The sound of your own footsteps and those with you, sound like a jet engine in comparison to your surroundings. It is absolutely beautiful. And the colors magnificent. Sometimes I wonder if, just like your sense of hearing seems heightened, whether the same thing happens with vision, when you aren't bombarded by manufactured advertising competing for your attention. I have some great photographs, but you are going to have to wait till I get back to the States to see them. Anything less than downloading them at full capacity just isn't fair to the beautiful people and landscape that i was privledged to experience. The peace that comes over you is almost intoxicating.
The beauty of human beings when they are not self conscious. I believe that in the West, from a very young age, we are taught to be self conscious. Not that its a bad thing--but when we are taught manners, how to eat, how to introduce ourselves... we are really building up self conciousness (in my opinion). I forget that-- until I am around people that are not self conscious. Their movements are beautiful, natural. It's hard to describe--adults and children alike, when they are wholly unconcerned by your perception of them. The way they sit, walk, use their hands, even just something as simple as the way they look at you. It is so simple and yet so intense after being so many steps removed from it.
When you are out and about in India, if you are from the West, you will be stuck by the litter, the cow dung, the filth that covers the streets and all public spaces. What most visitors never see, are the inside of a dwelling besides perhaps a hotels, restaurants, or shops. Every hut, big or small, or larger house--was immaculate. Even if the floor was unpaved, it was clean. I just want to point out, that there is a VAST difference in the way public and private space is viewed. The wealthiest and the poorest here will litter freely. But both will also keep their own houses clean. I find that really interesting--I think understanding why will be the key to cleaning up india--not just for aesthetics, but also for the sake of public health.
Let's talk about customs. It is an Indian custom to remove your chappals (indian word for flip flops) or shoes before entering a persons house. So I did this everytime I entered a house, big of small, dirt floor or marble floor. And, for unknown reasons, I really enjoy it! Another custom, it is as if indian people are really really uncomfortable with standing humans. Even if you are there for 2 seconds, you will be repeated asked to sit if you are standing. I think it just comes from the incredible hospitality. And rich or poor, they will all offer you something to eat or drink, even if it is the last of what they have if you are a new visitor. It makes my heart hurt with the sweetness of it all. Wednesday, is also some type of holy day that I haven't quite figured out. But just about everyday, most women in the city, and all in the villages, adorn their hair with beautiful, bright, fragrant flowers--but on wednesday, from what i gather is for religious reasons, everything is adorned even more. Everywhere I went, people kept putting flowers in my hair. One woman, after frustration with flowers falling out of my hair repeatedly, went and got one of her own bobbypins to secure her gift to me in my hair! In front of all of the houses, there is artwork on the ground at the enterance. Some of it is amazingly intricate (pictures coming). And some remake the design everymorning! The other student that was with me kept asking about adornments, and these house markings, for the reasons behind them. The nurses often just replied--because its beautiful, its for aesthetics. Beyond that, I would go so far to say that color is a custom here. From the clothes drying on the lines, bangles adorning even the infant females, flowers in the hair, and so on--the brilliance and intensity of color is striking. I was thinking it would be a fun experiment to give a western kiddo and an indian kiddo the same coloring book and box of crayons and see the differences that result!
I just want to talk a little about CHAD--the community health and development hospital that i was working at this week, so that you understand how the home visits fit into the vision. I had an amazing time talking to a Mr. Ranjeet this morning. He is the coordinator for visitors to CHAD and also one of the most informative people I met about the program. We talked about the two goals--interwined but inherently different entitites--health and socioeconomics. He started the discussion by pointing out that the poor will only spend money on health, or make it a priority, when there is some money above and beyond what is needed for food, water and shelter. That is why there is a socioeconomic component to the program. Sure, maybe if no one is sick, they spend extra money on a luxury or comfort--right now the fad is a color TV--which the people here can afford that they couldn't ten years ago. Odd as it seems to see a huge color tv in an unpaved, thatched roof hut--he points out that it makes a great bartering tool if someone falls sick and requires hospitalization. It just struck me as so sad. Very few would disagree that health should be considered a basic human right. But when you get down to the poorest of the poor, and you have to pick out necessity--it is more important to eat than have good health. Thats just a fact. So to give them some more income--they developed programs such as a daycare called a balwadi--where kids can go before they reach school age--and with that you create two income families. Tamil Nadu has declared that there should be a balwadi every two kilometers, in all inhabited areas, so no mother has to travel further than that to have subsidized child care. These daycares are subsidized by the government, there is supervision, education, and meals provided. They also give a protein and vitamin nutritional supplement. A doctor visits once a month to do well child check ups and the nurses monitor the weights of the children and classify level of malnutrition. It's brilliant. The economic development programs target women, mostly because agriculture is hard work, but profitable--so they don't want men to take up other skills. Interesting.
Mr. Ranjeet also said that this has all had unexpected consequences. The structure of the family ten years ago was a combined family. Parents would have children, the males would marry, daughter in laws would move in and have children, real daughters would be married off to go live in their in laws house. The son's would work, bring back the money and give it to the elder to then take care of finances. Well, when women started working, they didn't like the idea of giving money to some old guy that wasn't their real dad, that might get spent on the new kid of another brother's wife instead of her kid. So she turns to her husband and says, with our two incomes lets move out. Boom. In less than ten years now nuclear families predominate. So whats the big deal you might say? The combined family provided a forum for disputes between husband and wife. It provided community for kids and wives to talk to people other than direct siblings or husbands. Divorce has skyrocketed. Adolescents, without someone to vent to, and the elderly, without sons to maintain their houses--are committing suicides at astronomical rates. I was speechless (and you all know that is a rare event).
What did I see in the village?
I saw an elderly man, whose ear was swollen to the size of an orange. It was infected secondarily after a suicide attempt of pouring hot oil over himself and scalding off half his skin. He won't go to the hospital because he still wants to die, and hope the infection kills him. I saw a woman whose husband was killed when a bull gored him at a festival where they get the bulls drunk and wrestle them. She has a one and a half year old daughter. She will probably be kicked out of her in laws house since she did not have a son, and a granddaughter is just added expense. She is not allowed to wear bangles, or adorn her hair with flowers, or wear bright colors now that she is a widow--making her the lowest of the low. There was a nuclear family of four where the father had died (I don't remember how). The mother was unskilled, so she sent her son away to a factory to work for some months to make money to support her, his siblings, and a 7 year old cousin that was orphaned because his parents died of AIDS. He has HIV. The son that went away to work? He is 10. There was more. Suffice it to say, there was so much inner turmoil and unrest in this outwardly peaceful environment. Amongst all this, people were all smiling and hopeful. Gracious and open.
I love the children. I love that they are being taken care of by CMC, the government, their families. I love that in these new day cares, they know their days of the week, alphabet, numbers, in tamil and in english, by the age of three. I love that their mothers are learning skills and investing in them. I love the hope.
sorry this blog was so disjointed. it will probably be awhile before i am able to put it all together so I just figured i'd put it out there as it is to me now. Ambivalence abounds.
Tuesday, February 6, 2007
know that little parenthetical insertion at the end of my last blog?
the one about how I hoped i wouldn't regret saying that my stomach was so far so good?
well as you can see from carla's blog, that only lasted about a day. but thankfully, cipro in india is only about a dollar. and im cured and back to eating anything i please.
we went to pondicherry, it was really weird. i kept saying to carla that I didn't feel like I was in India. The french influence was definately seen in the architecture. Although there was nothing really special about my spaghettiSeveral of the restaurants that we went to, I was the only Indian person dining there--the rest of the people were all white with all indians serving them. It was so weird.
while there we went to this weird ashram that felt more like a cult: we weren't allowed to go to the "compound" (yes they called it that) until we had watched a five minute video. I was convinced we were about to be brainwashed. The people that lived at the ashram were mostly old white hippies. The whole idea is that they are trying to build a city in south india that is international, based on human unity. You have to renounce all religions and symbols to join, and then they give you a new symbol--a crystal ball to focus on in the middle of their all white interior "temple". anyway im not going to waste more time explaining it. If you really want to know here is the website: http://www.auroville.org/
We told the driver "NO ASHRAM" but he still took us there, and so instead of making him turn around, we went inside. Thats basically the attitude you learn to adopt--things sometimes just happen to you here--you roll with them (like once carla was asking for a bucket of hot water to bathe with, and the guy came back with a roll of toilet paper--totally proud that he figured out what she wanted--carla just said thank you and closed the door;)
So today I started at the community hosptial called CHAD. Last week, I was at a tertiary care hospital, that means, it has all the fancy CT, MRI, etc machines. The hospital I am at now is a secondary care facility, meaning, its nothing fancy. They have one ultrasound and one EKG machine, no ability to xray, and a bunch of rooms, doctors, and nurses and lots and lots and lots of patients. Today, I walked by what was labelled as there ICU--there was not a single piece of equipment in there! Only beds! My first thought was, I hope nothing bad happens to me here, or else, I will be in an ICU without anyway to save me! They refer all the tough stuff back to the hospital I was at last week, but this is a nice way to be closer to the rural folks that they serve and provide basic services for them. Next week I am at a primary care center realllllly out in the rural areas, apparently there is only one IV kit in the whole place and nothing else but some nurses and doctors.
Today, I rotated on the obstetrics ward--pregnant woman dont look all that pregnant in sari's. Especially malnourished pregnant women. I was assigned to wards for the day and sort of just fell onto the OB ward. I was working with Dr. Daisy--WHO IS PHENOMENAL. She is an OB/Gyn that has been practicing for 25 years. If you were to calculate amount of knowledge earned per hour of medical school, I probably had my most productive morning ever. The wonderful thing is, everything she said, was in context of the patient. You would think "duh", but unfortunately, that's not always the way th practice of medicine is taught. The first patient we saw had a Hb of 4.0 and was asymptomatic. For the nonmedical types, that is like losing half the oxygen capacity of your blood--She got the count because of her mouth. Her tongue was ghostly white, the edges of her mouth were cracked and dry and discolored (cheleosis). Basically, she had the diagnosis, long before the blood work came back. Then the question was weather to transfuse--how did she decide? She found out the details of this woman's life. She has a 1.5 year old child that has just learned to run around. She spends the day cleaning up filthiness, and lives in a very poor environment. With a blood count that low, it would be hard to keep up with her child and not get an infection. Raising her blood count slowly would take at least three months of Iron therapy. Speaking of Iron therapy--what is the best way to administer it? Well diet is better than supplementation--but in the context of this woman's situationn? Well, given the diet of poor people in india, it is unlikely that she could afford to eat foods high in iron. It is a very carbohydrate heavy meals that most poor folks can afford. How does one increase Iron absorption-Vitamin B complex and Vitamin C--but limes are expensive three for five rupees (43 rupees equals a dollar) so we supplement her supplement. I learned all this from the first patient. There were 20 that morning, and Dr. Daisy made sure we learned everything about everyone. From each patient, I learned about the social situation of my patients, the physical signs of their illnesses, the appropriate treatment for their illness, and how to make it a reality within their limited resources. Not easy stuff. Especially when dealing with gender dynamics in India, with an uneducated population, that knows little about contraception, pregnancy, nutrition, or health.
One day, I want to teach just like Dr. Daisy.
Over lunch, I met many of the residents and other visiting students. So much fun! Talking to other people interested in international health. We talked about everything though. The conversation I found most interesting was over the idea that india, at least up till now, has been protected from the western influence that has overcome may other countries because western people just can't figure it out. For example, each of the shops here sells, what to me and likely any other western person, is an ecclectic mix of goods, either all medicines, or bangles and eyeliner, or dishes and clothes. I am at a loss without a walmart or at least other organized specialty stores, of how to efficiently find all the things I would go shopping for on a daily basis. Yet talking to Indian residents, they all believe that all progress is good. I tried to explain how chains have made many communities loose thier culture and their uniqueness. How efficiency and progress have made people not know the people they buy their vegetables or clothes from, have made some streets in europe, or china, or brazil, look rather similar to any strip mall in the united states. its terrifying to me. I just don't want the whole world to look like cookie cutter streets, houses, clothing. What fun would it be to travel then? How will people have the joy, each time they travel to a new place, of rediscovering that the innate qualities of human beings is the same--regardless of food, clothing, cars, books, movies, etc. I love it every time. How will people take pride in their "unique" identity? Why do you think teenagers rebel? Conformity is downright boring.
Part of my angst is most certainly fueled by a book I am currently reading called "Fast Food Nation". I started it cause I heard I would never want to eat fast food again after reading it, and I admit, shallowly, that would be the best diet for me ever. Well, I started reading it and I am so shocked and sad. It is a well researched book and I believe every consumer in the United States should read it. Did you know Southern California used to be nothing but Orange Groves? Do you know what goes on in a meatpacking plant? Fast food industries control our congress (hence the minimum wage is 40% lower than it ever has been, adjusted for inflation), exploits teenage workers in this country, and is responsible for many of the health conditions that are fast becoming epidemics in our country, and that we are now exporting world wide. I know, free will exists. But read about how their advertising targets children in as young as three. It can also take quite a bit of work to exercise free will if McDonald's shut down the local eateries, and The Gap closed down little botique clothing stores. Anyways, not only do I not want to eat fast food, I don't want anything to do with any chain anywhere. And ask any of my friends, their are days where I would near sell my soul for a Big Mac (and now I know where it's manufactured taste comes from!). Exercising free will should not be an uphill battle in the land of the free. This book is powerful stuff. It's even more powerful reading it in India, where I have already gotten to know my little neighborhood, the people who serve the food where I eat, sell me my shampoo, and pour my tea--within a week. Can't say that about most places near my own home in the medical center. *sigh*
Anyway, by now, you should all be used to my rambling. After lunch, I went to the outpatient department, but no one was really as interested in teaching (I don't blame them, its hard work with patients lined up, sitting in the hallway, all the way out the door--pictures later). So I went to find Dr. Daisy who was doing ultrasounds, to see what other wisdom she could impart. And I was glad I did. Here is what I learned (besides the tamil words for head, heart, back, stomach, etc).
1. Doctors in India spend alot more time with their patients than doctors in America.
2. Infanticide used to be a huge problem in India for female babies. It is now illegal to tell the sex of the baby to the parents.
3. Parent's are financially responsible for a woman, even after she is married, until she has successfully had her first child. If she gets morning sickness, she maybe sent away to her parent's house until she is better.
4. Body lanuguage really is 80% of communication. And a smile, is 100% communication.
I will elaborate later, now it is time for some more Indian dinner!
well as you can see from carla's blog, that only lasted about a day. but thankfully, cipro in india is only about a dollar. and im cured and back to eating anything i please.
we went to pondicherry, it was really weird. i kept saying to carla that I didn't feel like I was in India. The french influence was definately seen in the architecture. Although there was nothing really special about my spaghettiSeveral of the restaurants that we went to, I was the only Indian person dining there--the rest of the people were all white with all indians serving them. It was so weird.
while there we went to this weird ashram that felt more like a cult: we weren't allowed to go to the "compound" (yes they called it that) until we had watched a five minute video. I was convinced we were about to be brainwashed. The people that lived at the ashram were mostly old white hippies. The whole idea is that they are trying to build a city in south india that is international, based on human unity. You have to renounce all religions and symbols to join, and then they give you a new symbol--a crystal ball to focus on in the middle of their all white interior "temple". anyway im not going to waste more time explaining it. If you really want to know here is the website: http://www.auroville.org/
We told the driver "NO ASHRAM" but he still took us there, and so instead of making him turn around, we went inside. Thats basically the attitude you learn to adopt--things sometimes just happen to you here--you roll with them (like once carla was asking for a bucket of hot water to bathe with, and the guy came back with a roll of toilet paper--totally proud that he figured out what she wanted--carla just said thank you and closed the door;)
So today I started at the community hosptial called CHAD. Last week, I was at a tertiary care hospital, that means, it has all the fancy CT, MRI, etc machines. The hospital I am at now is a secondary care facility, meaning, its nothing fancy. They have one ultrasound and one EKG machine, no ability to xray, and a bunch of rooms, doctors, and nurses and lots and lots and lots of patients. Today, I walked by what was labelled as there ICU--there was not a single piece of equipment in there! Only beds! My first thought was, I hope nothing bad happens to me here, or else, I will be in an ICU without anyway to save me! They refer all the tough stuff back to the hospital I was at last week, but this is a nice way to be closer to the rural folks that they serve and provide basic services for them. Next week I am at a primary care center realllllly out in the rural areas, apparently there is only one IV kit in the whole place and nothing else but some nurses and doctors.
Today, I rotated on the obstetrics ward--pregnant woman dont look all that pregnant in sari's. Especially malnourished pregnant women. I was assigned to wards for the day and sort of just fell onto the OB ward. I was working with Dr. Daisy--WHO IS PHENOMENAL. She is an OB/Gyn that has been practicing for 25 years. If you were to calculate amount of knowledge earned per hour of medical school, I probably had my most productive morning ever. The wonderful thing is, everything she said, was in context of the patient. You would think "duh", but unfortunately, that's not always the way th practice of medicine is taught. The first patient we saw had a Hb of 4.0 and was asymptomatic. For the nonmedical types, that is like losing half the oxygen capacity of your blood--She got the count because of her mouth. Her tongue was ghostly white, the edges of her mouth were cracked and dry and discolored (cheleosis). Basically, she had the diagnosis, long before the blood work came back. Then the question was weather to transfuse--how did she decide? She found out the details of this woman's life. She has a 1.5 year old child that has just learned to run around. She spends the day cleaning up filthiness, and lives in a very poor environment. With a blood count that low, it would be hard to keep up with her child and not get an infection. Raising her blood count slowly would take at least three months of Iron therapy. Speaking of Iron therapy--what is the best way to administer it? Well diet is better than supplementation--but in the context of this woman's situationn? Well, given the diet of poor people in india, it is unlikely that she could afford to eat foods high in iron. It is a very carbohydrate heavy meals that most poor folks can afford. How does one increase Iron absorption-Vitamin B complex and Vitamin C--but limes are expensive three for five rupees (43 rupees equals a dollar) so we supplement her supplement. I learned all this from the first patient. There were 20 that morning, and Dr. Daisy made sure we learned everything about everyone. From each patient, I learned about the social situation of my patients, the physical signs of their illnesses, the appropriate treatment for their illness, and how to make it a reality within their limited resources. Not easy stuff. Especially when dealing with gender dynamics in India, with an uneducated population, that knows little about contraception, pregnancy, nutrition, or health.
One day, I want to teach just like Dr. Daisy.
Over lunch, I met many of the residents and other visiting students. So much fun! Talking to other people interested in international health. We talked about everything though. The conversation I found most interesting was over the idea that india, at least up till now, has been protected from the western influence that has overcome may other countries because western people just can't figure it out. For example, each of the shops here sells, what to me and likely any other western person, is an ecclectic mix of goods, either all medicines, or bangles and eyeliner, or dishes and clothes. I am at a loss without a walmart or at least other organized specialty stores, of how to efficiently find all the things I would go shopping for on a daily basis. Yet talking to Indian residents, they all believe that all progress is good. I tried to explain how chains have made many communities loose thier culture and their uniqueness. How efficiency and progress have made people not know the people they buy their vegetables or clothes from, have made some streets in europe, or china, or brazil, look rather similar to any strip mall in the united states. its terrifying to me. I just don't want the whole world to look like cookie cutter streets, houses, clothing. What fun would it be to travel then? How will people have the joy, each time they travel to a new place, of rediscovering that the innate qualities of human beings is the same--regardless of food, clothing, cars, books, movies, etc. I love it every time. How will people take pride in their "unique" identity? Why do you think teenagers rebel? Conformity is downright boring.
Part of my angst is most certainly fueled by a book I am currently reading called "Fast Food Nation". I started it cause I heard I would never want to eat fast food again after reading it, and I admit, shallowly, that would be the best diet for me ever. Well, I started reading it and I am so shocked and sad. It is a well researched book and I believe every consumer in the United States should read it. Did you know Southern California used to be nothing but Orange Groves? Do you know what goes on in a meatpacking plant? Fast food industries control our congress (hence the minimum wage is 40% lower than it ever has been, adjusted for inflation), exploits teenage workers in this country, and is responsible for many of the health conditions that are fast becoming epidemics in our country, and that we are now exporting world wide. I know, free will exists. But read about how their advertising targets children in as young as three. It can also take quite a bit of work to exercise free will if McDonald's shut down the local eateries, and The Gap closed down little botique clothing stores. Anyways, not only do I not want to eat fast food, I don't want anything to do with any chain anywhere. And ask any of my friends, their are days where I would near sell my soul for a Big Mac (and now I know where it's manufactured taste comes from!). Exercising free will should not be an uphill battle in the land of the free. This book is powerful stuff. It's even more powerful reading it in India, where I have already gotten to know my little neighborhood, the people who serve the food where I eat, sell me my shampoo, and pour my tea--within a week. Can't say that about most places near my own home in the medical center. *sigh*
Anyway, by now, you should all be used to my rambling. After lunch, I went to the outpatient department, but no one was really as interested in teaching (I don't blame them, its hard work with patients lined up, sitting in the hallway, all the way out the door--pictures later). So I went to find Dr. Daisy who was doing ultrasounds, to see what other wisdom she could impart. And I was glad I did. Here is what I learned (besides the tamil words for head, heart, back, stomach, etc).
1. Doctors in India spend alot more time with their patients than doctors in America.
2. Infanticide used to be a huge problem in India for female babies. It is now illegal to tell the sex of the baby to the parents.
3. Parent's are financially responsible for a woman, even after she is married, until she has successfully had her first child. If she gets morning sickness, she maybe sent away to her parent's house until she is better.
4. Body lanuguage really is 80% of communication. And a smile, is 100% communication.
I will elaborate later, now it is time for some more Indian dinner!
Friday, February 2, 2007
Of course I believe that the key to world peace is for cultures to focus on their similarities rather than their differences...
But one of the fun thing about different cultures are the things you find curious because they would be so out of the ordinary within your own place and time. These things are best seen when brand new to a place; when I get home, i'll dig out some of my pictures from previous visits to india, which mostly consist of pictures of cows in the market place. anyhow, here are a few things I have enjoyed thus far in vellore (some things never get old) just while meandering about. Please forgive the size, you try downloading with 512 speed internet.
the friendly neighborhood goat. Also responsible for waste management.
One step ahead of the game. They are against all forms of tobacco pollution, not just smoking.
I would think there would be many other things you might want to ban from the hospital premises, but this is the only restriction I found.
It is a lovely hospital with lovely plants. Apparently, people have been trying to take them, since there are commandments every few feet prohibiting it.
Carla and my first ride in the back of an "autorickshaw"
Me in ethnic garb outside the biochemistry labs (!) garden. If only our campus were so lucky.
My favorite thing about india is the vast array of colors (yes I know, ironic for a black and white photographer). No better place to spot it than at a tailor.
Hopefuly more (and larger) pictures to come.
the friendly neighborhood goat. Also responsible for waste management.
One step ahead of the game. They are against all forms of tobacco pollution, not just smoking.
I would think there would be many other things you might want to ban from the hospital premises, but this is the only restriction I found.
It is a lovely hospital with lovely plants. Apparently, people have been trying to take them, since there are commandments every few feet prohibiting it.
Carla and my first ride in the back of an "autorickshaw"
Me in ethnic garb outside the biochemistry labs (!) garden. If only our campus were so lucky.
My favorite thing about india is the vast array of colors (yes I know, ironic for a black and white photographer). No better place to spot it than at a tailor.Hopefuly more (and larger) pictures to come.
Today was the last day of my pediatric rotation at the main CMC hospital. Yesterday and today, I enjoyed talking with Dr. Moses, the director of child health. He is an excellent teacher, compassionate, patient, and articulate. (I believe he is an idealist at heart; perhaps it was that, that reminded me of William Wimsatt when he was talking). From my last post regarding all the talk about payment--he summed up his philosophy on money and health care. He notes that everyone is poor, to a different extent. And if those that have the ability to pay, get away without paying and going on the hospital's handout, it takes away the funds available for those who truly cannot pay. Sorting out who is who can be difficult, hence the need to discuss it ad nauseum with the families, and to gain an accurate social history for each patient. I tried to think about why it was that it did not bother me when he talked about money, compared to some of the other doctors. It was really his attitude that was so different. I try to take into context the fact that as director, he probably has alot more experience and distance, making it easier for him to deal with limited resources so maturely. Perhaps the other doctors are as flustered by the whole complexity of it as I am--the difference is, they have to live it day in and day out. I have to flag this little section about my frustration to reread during those difficult times as an intern next year. It could be so much harder than what I will face. It is so much harder over here. On Monday, I will start my rotation at CHAD, a community hospital. Till then, I have the weekend to figure out how not to keep waking up between midnight and 3AM, and then being utterly exhausted by dinner.
Dr. Moses told us about the history of CMC, started by a little girl who was here because her parents were doing missionary work. She was approached by a muslim man who asked her to come and attend to his wife who was in a difficult labor. She replied that she was not a doctor but her father was, could he attend instead. The man replied that it was strictly against his beliefs for a man to attend to the birth, only a woman could do it. She refused as she had no medical training, after pleading with the man to let her father help. Later that evening, she was approached by a Hindu man in the same situation, once again, she could do nothing to help. Yet a third man (I forgot the religion) was in the same situation that evening. She was upset throughout the night at her helpless situation. In the morning, she heard the bell toll for the three mother's who had died in child birth. It was then that this little girl decided she had to do something. From this story, comes the beginning of the Christian Medical College. From her feelings of helplessness, she empowered and served so many; she continues to do so through her legacy. Inspiring. to say the least.
Carla and I have been a bit adventurous and testing of our limits when it comes to food. So far, we are in the clear. We have been eating at many of the different little restaurants along Ida Scutter Road, the main street in front of the hospital. This weekend we are going to Pondicherry--it is a little coastal town that has French influence, according to our almighty guide book. We also arranged for our travel after our rotation at CMC, we will be going to Goa--the other coast that has Portuguese influence, and then to Jodhpur and Jaisalmer in Rajasthan, thats right, where I will finally get to see the palaces of the great maharajas (I have wanted to forever, why I haven't yet? we'll get to that in a moment...) and Carla will get to fulfill her long unfulfilled wish to ride a camel on a night safari! Afterwards we will head to Delhi where we will stay with my masi (that is an aunt on the mother's side, "masi" means "like mother"... a heart warming term isn't it? I much prefer it to "aunt".), see the taj mahal as a day trip to agra, and partake in some serious shopping. Should be lovely?
So back to this travelling bit. I've been to India for two big trips in my life (in my memory). Why have I never seen Goa or the palaces I've always longed to see? Well, it has something to do with the Great Relative Tour that happens on India Standard Time (IST). IST (at least in the north), is pretty much two hours after the time that is agreed upon or greater. The Relative Tour? If you are of indian decent. You could spend three full weeks, three to four meals a day, visiting with relatives in mass quantities at each meal, and STILL have forgotten or missed someone--combine that with IST, and you have a synergy that is unconquerable in the proportioned time that American School Systems like to hand out as vacation (most of you know my qualms with the System--you couldn't possibly learn something outside a sterile room, with books so edited that there is no life left to them, between the hours of 8-4. Right?). Sorry for the aside. Well, on this trip, I will not be making the Relative Tour (I hope there is no grudge held for twenty something odd years, finger's crossed).
My grandmother lives in Shillong; it is a Christian state close to China with a more (indigenous?) population of people that descend from a mix of Indian and Chinese--with their own language, customs, etc. I always found this fascinating as the only other aspect of India I knew was the predominantly Hindu, huge city of New Delhi. That always kept me wondering, if this is so different from the "India" I know, what else is there? On my last trip to India, my brother and I disappeared to Kerala for three days--it is at the Southern most tip of India where the three oceans meet. It is beautiful. It is a matriarchal system, where property is passed from mother to daughter and has one of the highest literacy rates in the developing world (coincidence? my guess is no;) This made my curiosity grow further. That is why I am excited to live here in Tamil Nadu, with a large Christian population (yes, in another life, I would have been a full fledged anthropologist), then see a town with French influence, and then another with Portuguese influence! I'm so excited. So why the fascination with palaces? On my last trip to India, I picked up a book by Gita Mehta called "Raj". She is a historical fiction writer. I became enthralled by her description of not only the physical brilliance of the palaces, but also the history of their fall. At the rate our world is going, I feel the need to see them now rather than later.
This is also the first time I would say I have actually "lived" in India. Where not everything is arranged for me, bought for me, cooked especially for me, booked for me during my whole stay. I like it. I think I grew up scared of the "differences" in India compared to the states--don't eat the street food, watch your purse at all times, let so and so take you shopping, take a hired A/C car everywhere. Not that these aren't all valid concerns. But even after travelling to the other parts of the world and managing on my own, I guess I didn't know I could do that here. Maybe I pay a few extra rupees, sweat a few more drops, and risk my stomach (hope I don't regret this later)--but I'm having a blast figuring it out. Obviously, its about the journey, my destination is intangible.
whew. if you made it this far, good work;)
Wednesday, January 31, 2007
"Polio vaccines have eliminated polio from most of the world and reduced early cases from hundreds of thousands yearly to only 1000 in 2001."
But that doesn't really matter if it happens to be your child with suspected polio.
Yesterday afternoon, I began my rotation with the pediatrics ward team. We were there for about three hours and it was probably the most ambivalent rush of feelings I have had in a long time. It took me sometime afterwards to process it (not sure it's fully processed) and the effort exhausted me. It was a combination of wonder, excitement, frustration, anger, and helplessness. I attended afternoon rounds... what I saw was that more than half the time was spent in discussing payment issues, idle chit chat, or concern over being busy... more on this later...
The hospital smells of formaldehyde. When Carla and I were sitting in the director's office, I turned and asked her, what IS this familiar smell that I can't place? She immediately replied "anatomy lab" and she was right on. We were told to come back in a little while because an attending was still at lunch. On rounds, for the first time since college, I wanted to be an infectious disease specialist... we saw rickettsia (i never knew it could present with skin lesions of the devastating sort that I saw), suspected polio, bilateral bronchopneumonia, multitude of gastric complaints associated with fever, salmonella, possible meningitis, suspected primary TB--all within a matter of minutes of stepping foot into the ward.
The ward made me feel like I was in a time warp. The nurses all wore white sari's with plastic nurses hats. When we entered the PICU, we had to take our shoes off and go barefoot! The attending never washed his hands... in between all these infectious disease patients! I think he heard carla point it out to me, because from then on, he was constantly washing his hands... I don't think carla or I intended for him to hear us, but its better for the patients anyhow--and in my training--i understand the well being of the patient to be the end all be all of the actions. Also, the attending pointed out that when they need to attain urine samples, if a midstream clean catch is not possible (patient too young, contaminated specimen), they routinely do a suprapubic cath! For those outside medicine, this is an invasive procedure involving piercing the lower pelvis directly into the bladder to get a urine sample. We asked, why not just do a regular in and out catheter? The attending said he is "absolutely against catheters. They will inevitable introduce infection." Hmmm. I wonder why that is. The attending was excellent about teaching points and introducing each patient's history for our benefit. At the end, he left us in "pediatric casualty" which is their ER... I saw a patient with 30% third degree burns... I worry every two minutes since I saw him about his infection risk. I feel that there is alot than can be done to improve outcomes just from what I saw in the first few hours. Not expensive changes. Just behavioral ones-the Semmelweis type.
So why the feelings of helplessness... As I was trying to make sense of my feelings yesterday, here is what I came up with. In India, you will see the poorest of the poor, walk by the sickest of the sick, everyday, on every street. This has been true in every city of India that I have ever been in. As you walk by, they will call out to you, drag their bodies, with missing limbs, up to you, with pleading, begging eyes, motioning with their hands, their desire to eat something. I recently read Kurt Vonnegut's "A Man Without A Country", where he points out America is the only country with fat poor people. In India, "scaphoid abdomen" takes on a whole new meaning, as you wonder how long the skin can possibly continue to hold in whatever is left. Sorry to be graphic. But it is very real and it is omnipresent. So, I don't know if this is everyone's immediate reaction, but mine is to put up walls. If I were to process the poverty and sickness with each person I passed, and face up to the complexity of inhumanity, limited resources, failure of government, failure of humans to take care of one another, the gross inequity between my yesterday and my today, I would not make it two feet (or 0.6 meters, depending where you are) without breaking down. And yet, my ability to walk by, is likely the same defense that humankind has in allowing this to go on.
I just kept thinking "positive thoughts". Yes, this absolutely sucks, but I am here to see what is being done about it, so I walk on passing one after another of sadness personified on the street. So you see, when I got to the wards, and heard all this talk about not ordering needed antibiotics or tests due to payment issues, turning away a child without the ability to pay even with the high likelihood of polio at the top of the differential, watching worried mother after worried mother, have to make decisions about feeding all her children, or paying for medication for her sick child, and it goes on--helplessness and frustration overwhelmed me. Many times, the doctors talk in English, make a plan, and do not even inform the parents of the plan or updates on what they think is going on. In the states, I can at least go back and talk to the families if something like this happens. But here, the pathology is beyond what I have seen in infectious disease, and I do not speak the language. I am literally useless.
And being that I am Rupa, I am ambivalent. Who am I to judge a country with such limited resources, or the doctors that dare to take on the challenge? Of course they have to worry about payment if they want the hospital to exist another day. Maybe their defense mechanism for making it through the day is to have idle chit chat to break up the reality or to take pride in the busyness, even if they approach it at their own pace. But in Rupa's idealistic mind...ability to pay should only factor into cost effective use of resources... not life or death decisions. Yes we have the ability to save your child's life. No we will not do it if you cannot pay. Don't get me wrong; do not think for a minute that health care is treated as a basic human right in the United States either... its just that the level of drastic measures that are sought are at a different level in a developed versus a developing nation. Deep Breath.
Today, we had a different attending. The child with (likely) polio ended up being admitted. We saw an excellent physical exam... with the attending assessing the child's motor movements through play, establishing herself with him, and continuing on. She would do some parent education on rounds, which helped me breath a little easier. I also went to a barium swallow for a child that has had bilious vomiting for 6 days. The pediatric surgeon refreshed my embryology with understanding volvulus and malrotation. I don't think I will ever forget it--i had never seen volvulus before. The surgeon also made me realize that I need to be reading more to keep up with my basic sciences. It has been so easy to get caught up in this love affair with the clinical efficiency of things in the past two years. A little bit of grounding is good every now and then. I have to remember the "why" behind the "what."
The attending today also pointed out that their hospital is private and the poorest of the poor never even make it through the doors. Few and far between. One of the patients I saw today is part of a family of three that lives off 200 rupees a week. That is approximately $5. It is what Carla and I spent together on lunch today. Coming back from lunch, I saw grandmothers asleep on the cool cement floor outside the ward, others eating off the floor. Practically all the mothers are barefoot. I don't know that I could handle poorest of the poor.
We had a clinical meeting at 4pm. There we heard from an American Doctor that had done a research project in Bangladesh. The basic point of his, and his research appears valid and corroborated by others--influenza in the tropics follows a very different pattern than in temerate zones--present for most of the year in moderate amounts rather than the winter peak pediatricians have come to know and "love" in the Northern Hemisphere. Interesting.
I miss Jon. Besides being a good boyfriend. He's my best friend. He's the one that I talk to about all this stuff. and there is so much stuff, but no him to take in the earful.
Well, I am still a victim of jet lag... I continue to wake up by midnight every night. I have some pictures that I have taken while out and about, but I will have to figure it out later. I'm really excited about tomorrow. I hope I can continue to say that forever.
Yesterday afternoon, I began my rotation with the pediatrics ward team. We were there for about three hours and it was probably the most ambivalent rush of feelings I have had in a long time. It took me sometime afterwards to process it (not sure it's fully processed) and the effort exhausted me. It was a combination of wonder, excitement, frustration, anger, and helplessness. I attended afternoon rounds... what I saw was that more than half the time was spent in discussing payment issues, idle chit chat, or concern over being busy... more on this later...
The hospital smells of formaldehyde. When Carla and I were sitting in the director's office, I turned and asked her, what IS this familiar smell that I can't place? She immediately replied "anatomy lab" and she was right on. We were told to come back in a little while because an attending was still at lunch. On rounds, for the first time since college, I wanted to be an infectious disease specialist... we saw rickettsia (i never knew it could present with skin lesions of the devastating sort that I saw), suspected polio, bilateral bronchopneumonia, multitude of gastric complaints associated with fever, salmonella, possible meningitis, suspected primary TB--all within a matter of minutes of stepping foot into the ward.
The ward made me feel like I was in a time warp. The nurses all wore white sari's with plastic nurses hats. When we entered the PICU, we had to take our shoes off and go barefoot! The attending never washed his hands... in between all these infectious disease patients! I think he heard carla point it out to me, because from then on, he was constantly washing his hands... I don't think carla or I intended for him to hear us, but its better for the patients anyhow--and in my training--i understand the well being of the patient to be the end all be all of the actions. Also, the attending pointed out that when they need to attain urine samples, if a midstream clean catch is not possible (patient too young, contaminated specimen), they routinely do a suprapubic cath! For those outside medicine, this is an invasive procedure involving piercing the lower pelvis directly into the bladder to get a urine sample. We asked, why not just do a regular in and out catheter? The attending said he is "absolutely against catheters. They will inevitable introduce infection." Hmmm. I wonder why that is. The attending was excellent about teaching points and introducing each patient's history for our benefit. At the end, he left us in "pediatric casualty" which is their ER... I saw a patient with 30% third degree burns... I worry every two minutes since I saw him about his infection risk. I feel that there is alot than can be done to improve outcomes just from what I saw in the first few hours. Not expensive changes. Just behavioral ones-the Semmelweis type.
So why the feelings of helplessness... As I was trying to make sense of my feelings yesterday, here is what I came up with. In India, you will see the poorest of the poor, walk by the sickest of the sick, everyday, on every street. This has been true in every city of India that I have ever been in. As you walk by, they will call out to you, drag their bodies, with missing limbs, up to you, with pleading, begging eyes, motioning with their hands, their desire to eat something. I recently read Kurt Vonnegut's "A Man Without A Country", where he points out America is the only country with fat poor people. In India, "scaphoid abdomen" takes on a whole new meaning, as you wonder how long the skin can possibly continue to hold in whatever is left. Sorry to be graphic. But it is very real and it is omnipresent. So, I don't know if this is everyone's immediate reaction, but mine is to put up walls. If I were to process the poverty and sickness with each person I passed, and face up to the complexity of inhumanity, limited resources, failure of government, failure of humans to take care of one another, the gross inequity between my yesterday and my today, I would not make it two feet (or 0.6 meters, depending where you are) without breaking down. And yet, my ability to walk by, is likely the same defense that humankind has in allowing this to go on.
I just kept thinking "positive thoughts". Yes, this absolutely sucks, but I am here to see what is being done about it, so I walk on passing one after another of sadness personified on the street. So you see, when I got to the wards, and heard all this talk about not ordering needed antibiotics or tests due to payment issues, turning away a child without the ability to pay even with the high likelihood of polio at the top of the differential, watching worried mother after worried mother, have to make decisions about feeding all her children, or paying for medication for her sick child, and it goes on--helplessness and frustration overwhelmed me. Many times, the doctors talk in English, make a plan, and do not even inform the parents of the plan or updates on what they think is going on. In the states, I can at least go back and talk to the families if something like this happens. But here, the pathology is beyond what I have seen in infectious disease, and I do not speak the language. I am literally useless.
And being that I am Rupa, I am ambivalent. Who am I to judge a country with such limited resources, or the doctors that dare to take on the challenge? Of course they have to worry about payment if they want the hospital to exist another day. Maybe their defense mechanism for making it through the day is to have idle chit chat to break up the reality or to take pride in the busyness, even if they approach it at their own pace. But in Rupa's idealistic mind...ability to pay should only factor into cost effective use of resources... not life or death decisions. Yes we have the ability to save your child's life. No we will not do it if you cannot pay. Don't get me wrong; do not think for a minute that health care is treated as a basic human right in the United States either... its just that the level of drastic measures that are sought are at a different level in a developed versus a developing nation. Deep Breath.
Today, we had a different attending. The child with (likely) polio ended up being admitted. We saw an excellent physical exam... with the attending assessing the child's motor movements through play, establishing herself with him, and continuing on. She would do some parent education on rounds, which helped me breath a little easier. I also went to a barium swallow for a child that has had bilious vomiting for 6 days. The pediatric surgeon refreshed my embryology with understanding volvulus and malrotation. I don't think I will ever forget it--i had never seen volvulus before. The surgeon also made me realize that I need to be reading more to keep up with my basic sciences. It has been so easy to get caught up in this love affair with the clinical efficiency of things in the past two years. A little bit of grounding is good every now and then. I have to remember the "why" behind the "what."
The attending today also pointed out that their hospital is private and the poorest of the poor never even make it through the doors. Few and far between. One of the patients I saw today is part of a family of three that lives off 200 rupees a week. That is approximately $5. It is what Carla and I spent together on lunch today. Coming back from lunch, I saw grandmothers asleep on the cool cement floor outside the ward, others eating off the floor. Practically all the mothers are barefoot. I don't know that I could handle poorest of the poor.
We had a clinical meeting at 4pm. There we heard from an American Doctor that had done a research project in Bangladesh. The basic point of his, and his research appears valid and corroborated by others--influenza in the tropics follows a very different pattern than in temerate zones--present for most of the year in moderate amounts rather than the winter peak pediatricians have come to know and "love" in the Northern Hemisphere. Interesting.
I miss Jon. Besides being a good boyfriend. He's my best friend. He's the one that I talk to about all this stuff. and there is so much stuff, but no him to take in the earful.
Well, I am still a victim of jet lag... I continue to wake up by midnight every night. I have some pictures that I have taken while out and about, but I will have to figure it out later. I'm really excited about tomorrow. I hope I can continue to say that forever.
Monday, January 29, 2007
permanent brain damage
so last time i wrote was during my first layover in amsterdam.
now i am in vellore, registered for my rotations which begin this afternoon, checked into the hotel and already a market connosieur (don't know how to spell that).
but the times in between then and now... let me tell you...
so during our overnight layover in mumbai (or bombay for those of you not "with it" yet), we were supposed to be able to have a free dinner and lounge at a nearby hotel... there are two airports one is international the other is domestic--well there was no one there to pick us up to take us to the hotel, so we ended up on a shuttle where carla and i thoroughly explored the mumbai airport... found internet, indian junk food, the lounge we got kicked out of cause we are not "elite", and then a restaurant we got kicked out of cause we bought our food at the downstairs counter instead of the upstairs counter.
when we finally got to chennai we got a taxi driver. probably the only one in india that followed ALL the traffic rules. some might like this given the "i'm going to die" feeling i usually have when i travel on the roads in india. but after 48 hours without no sleep, i was looking forward to an aggressive driver for our 4 hour trip to vellore. carla and i just gave each other a sad look everytime someone passed us...cars, lopsided buses, rickshaws, people on foot, cows. i mean seriously, he drove the speed limit the whole way, and even stopped for tea.
so i did not sleep during the entire trip... im just not an airplane sleeper. so after 48 hours of travel time (including the longest layovers of my life) we arrived in vellore and decided we had to get situated. Somewhere in our delerium we decided it would be better to finish errands rather than sleep. so off we went in search of toilet paper, hand soap, a cell phone so you peoples can call us, photocopier for the documents we needed to register the next day, passport photos (oh they are lovely, let me tell you, without having brushed my hair or showered for three days, and now it is on my CMC ID card!) Why we did not go to sleep i do not know. but at some point, carla and i realized we had been waiting for someone that said "be right back" for an hour, and we still had no cell phone and both of us were too tired to realize it! so we decided to go to the hotel.
at the hotel, they first told us they didnt have any a/c rooms with two beds, which we had confirmed they had twice before we left. so carla and i have to get comfy. then, we got to our room to realize there is an elaborate key system that makes it so you cannot have the electricity on while you are gone, not a big deal, accept on hot days where it wuld be nice to be greeted with AC and that oh yeah, if we want to turn off the lights, the ac has to turn off too since none of the switches are actually connected to the light bulb--just to the superkey! we chose the airconditioning and sleeping wiht lights on since we were exhausted. but after a bit of rest, i awoke around midnight to find carla standing on the bed and desk unscrewing light bulbs. she is brilliant! i would have been sleeping with the lights on for three weeks without her. She also said something, but i can't remember what, that made me worry that our staying awake so long had caused permanent brain damage.
before we went to bed, carla and i decided to order food. poor delerious carla on the phone, lets just say that after a 20 minute conversation and four clarification phone calls on trying to order two items and two drinks... we got, half our food, he informed us the rest was still cooking. then he brought in the next order ten minutes later and the bill. then he brought the change 15 minutes later. then he came back to get the dishes. they don't like to knock here either.
now if we can just figure out how to get the hot running water they promised us...i think we will be okay.
okay, so it might sound like im complaining, but in my delerious state, i actually was enjoying the craziness of it. carla and i were giggling the whole time. when we first hit vellore it felt overwhelming, usually i get in "travel mode" when i get to another country but lack of sleep and food, made everything seem a bit surreal. its just about a different way of life, coming from someplace with a certain way of life and integrating, quick like, just takes being with it. but even if i usually consider myself travel savvy... a few things i learned... prioritize the basics when new someplace... sleep and food. they you can figure out the fancy stuff later...
but so far, today has been a blast. we both registered for our electives. This week, I am doing pediatrics. Next week I will be doing home visits and hospital rounds at the community health and development hospital. The following week will be at a rural location! i am really excited. everyone here is really nice, not just at the hospital, but also in the city. sure they want to sell you their stuff, but they are also willing to help you find something if you are lost, even if they don't speak your language or understand anything about you. Mostly, i would just describe the folks here as "curious", just like us. Even if they are staring at us, taking us in... we are staring back and taking it all in. in the end, its all the same. I keep my guard up, just like I do anytime I'm in a city, whether its New York or Belo Horizonte, but this is probably the most comfortable I have felt in a city. I'm excited to make this place home for three weeks. its very managable.
Well, this blog just came out as a regurgitation of events, not quite what I wanted, what I really wanted to do was tell you my thoughts on all these actions. my thoughts on dressing in indian clothes, being ethnically indian, but inherently american and here in this country as foreign to me as any other. but i think this blog came out the way that my first day felt, just event after event. so i'll get to the good stuff in the next one i suppose.
now i am in vellore, registered for my rotations which begin this afternoon, checked into the hotel and already a market connosieur (don't know how to spell that).
but the times in between then and now... let me tell you...
so during our overnight layover in mumbai (or bombay for those of you not "with it" yet), we were supposed to be able to have a free dinner and lounge at a nearby hotel... there are two airports one is international the other is domestic--well there was no one there to pick us up to take us to the hotel, so we ended up on a shuttle where carla and i thoroughly explored the mumbai airport... found internet, indian junk food, the lounge we got kicked out of cause we are not "elite", and then a restaurant we got kicked out of cause we bought our food at the downstairs counter instead of the upstairs counter.
when we finally got to chennai we got a taxi driver. probably the only one in india that followed ALL the traffic rules. some might like this given the "i'm going to die" feeling i usually have when i travel on the roads in india. but after 48 hours without no sleep, i was looking forward to an aggressive driver for our 4 hour trip to vellore. carla and i just gave each other a sad look everytime someone passed us...cars, lopsided buses, rickshaws, people on foot, cows. i mean seriously, he drove the speed limit the whole way, and even stopped for tea.
so i did not sleep during the entire trip... im just not an airplane sleeper. so after 48 hours of travel time (including the longest layovers of my life) we arrived in vellore and decided we had to get situated. Somewhere in our delerium we decided it would be better to finish errands rather than sleep. so off we went in search of toilet paper, hand soap, a cell phone so you peoples can call us, photocopier for the documents we needed to register the next day, passport photos (oh they are lovely, let me tell you, without having brushed my hair or showered for three days, and now it is on my CMC ID card!) Why we did not go to sleep i do not know. but at some point, carla and i realized we had been waiting for someone that said "be right back" for an hour, and we still had no cell phone and both of us were too tired to realize it! so we decided to go to the hotel.
at the hotel, they first told us they didnt have any a/c rooms with two beds, which we had confirmed they had twice before we left. so carla and i have to get comfy. then, we got to our room to realize there is an elaborate key system that makes it so you cannot have the electricity on while you are gone, not a big deal, accept on hot days where it wuld be nice to be greeted with AC and that oh yeah, if we want to turn off the lights, the ac has to turn off too since none of the switches are actually connected to the light bulb--just to the superkey! we chose the airconditioning and sleeping wiht lights on since we were exhausted. but after a bit of rest, i awoke around midnight to find carla standing on the bed and desk unscrewing light bulbs. she is brilliant! i would have been sleeping with the lights on for three weeks without her. She also said something, but i can't remember what, that made me worry that our staying awake so long had caused permanent brain damage.
before we went to bed, carla and i decided to order food. poor delerious carla on the phone, lets just say that after a 20 minute conversation and four clarification phone calls on trying to order two items and two drinks... we got, half our food, he informed us the rest was still cooking. then he brought in the next order ten minutes later and the bill. then he brought the change 15 minutes later. then he came back to get the dishes. they don't like to knock here either.
now if we can just figure out how to get the hot running water they promised us...i think we will be okay.
okay, so it might sound like im complaining, but in my delerious state, i actually was enjoying the craziness of it. carla and i were giggling the whole time. when we first hit vellore it felt overwhelming, usually i get in "travel mode" when i get to another country but lack of sleep and food, made everything seem a bit surreal. its just about a different way of life, coming from someplace with a certain way of life and integrating, quick like, just takes being with it. but even if i usually consider myself travel savvy... a few things i learned... prioritize the basics when new someplace... sleep and food. they you can figure out the fancy stuff later...
but so far, today has been a blast. we both registered for our electives. This week, I am doing pediatrics. Next week I will be doing home visits and hospital rounds at the community health and development hospital. The following week will be at a rural location! i am really excited. everyone here is really nice, not just at the hospital, but also in the city. sure they want to sell you their stuff, but they are also willing to help you find something if you are lost, even if they don't speak your language or understand anything about you. Mostly, i would just describe the folks here as "curious", just like us. Even if they are staring at us, taking us in... we are staring back and taking it all in. in the end, its all the same. I keep my guard up, just like I do anytime I'm in a city, whether its New York or Belo Horizonte, but this is probably the most comfortable I have felt in a city. I'm excited to make this place home for three weeks. its very managable.
Well, this blog just came out as a regurgitation of events, not quite what I wanted, what I really wanted to do was tell you my thoughts on all these actions. my thoughts on dressing in indian clothes, being ethnically indian, but inherently american and here in this country as foreign to me as any other. but i think this blog came out the way that my first day felt, just event after event. so i'll get to the good stuff in the next one i suppose.
Saturday, January 27, 2007
my first layover
is in amsterdam where I am currently writing from. carla and i are sitting at opposing computers at 8am (we just paid 6 euros for very little internet time. i dont even know what the conversion rate is right now, ive really been in hiding)... really 1am in United States superpower time. Being awake right now really reminds me of being on call, you know, that slightly loopy, giggly feel.
so when i was packing i was weary of travelling anymore, after my interview trail of fire, but I woke up really excited. i finally get to work in the medical field in another country! i've been waiting forever to get to this point. I think i am also excited because this trip marks being done with my interviews, rank list, and all that. so i just have to wait till march 15th. this will make time fly!
so many people assume that because I am ethnically Indian, I will know what is going on. From my brief prior experience vacationing in Kerala 3 years ago, I can tell you that south india is basically a whole different world than the north india that I know from relative visiting, etc. Different language, culture, food, dress, religion, roads. So we will see if chennai and vell;ore are similar. We arrive in bombay next and have a 6 hour layover. before flying to chennai and then taking a four hour taxi to vellore. you want to talk about post call giddiness? this will be a whole new level of silly rupa.
I packed very light. A few pairs of pants and shirts and basics. I am going to dress in traditional indian garb while working. i brought my bro's digital camera (no i have not given up on film, just taking a break)so perhaps i'll post some pics. carla's travel blog is mytravelbabble.blogspot.com... for additional pics.
will write again when something exciting happens!
so when i was packing i was weary of travelling anymore, after my interview trail of fire, but I woke up really excited. i finally get to work in the medical field in another country! i've been waiting forever to get to this point. I think i am also excited because this trip marks being done with my interviews, rank list, and all that. so i just have to wait till march 15th. this will make time fly!
so many people assume that because I am ethnically Indian, I will know what is going on. From my brief prior experience vacationing in Kerala 3 years ago, I can tell you that south india is basically a whole different world than the north india that I know from relative visiting, etc. Different language, culture, food, dress, religion, roads. So we will see if chennai and vell;ore are similar. We arrive in bombay next and have a 6 hour layover. before flying to chennai and then taking a four hour taxi to vellore. you want to talk about post call giddiness? this will be a whole new level of silly rupa.
I packed very light. A few pairs of pants and shirts and basics. I am going to dress in traditional indian garb while working. i brought my bro's digital camera (no i have not given up on film, just taking a break)so perhaps i'll post some pics. carla's travel blog is mytravelbabble.blogspot.com... for additional pics.
will write again when something exciting happens!
Friday, January 26, 2007
tomorrow im off
i'm packing minimally, and yet travel preparations are always ardous.
i know i've only just finished my interview trail in the states and here i'm off again!
exciting!
driving to houston in the morning to meet up with carla. hope you enjoy sharing my adventures!
i know i've only just finished my interview trail in the states and here i'm off again!
exciting!
driving to houston in the morning to meet up with carla. hope you enjoy sharing my adventures!
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