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!