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.