Now that I am back in the land of filtered gasoline, wide-open spaces, and bleach-based cleaners, India seems like one long trip on acid. The vivid colors, the mass of people, the frenzied traffic and vibrant smells- one millisecond sweet jasmine, the next raw sewage.
If I had left India after a few weeks, I would have been ready to leave, remembered mostly the unpleasant and inefficient, and would have seamlessly resumed daily life at home.
A month, however, took away the luxury of dismissing the problems of a third world country by forcing me to imagine myself a true part of the culture and someone who must come psycologically come to grips with the humanity squashed around me.
Of course, I don't know how it would feel to actually live in India, to even visit for longer than a circumscribed short period of time. Someday, perhaps, I will!
In the meantime, though, I feel so thankful that I could go and lucky that I met so many interesting people. It is a very nationalistic country, filled with diverse peoples and religions, privy to major construction and changes in its labor force. We could learn alot not just from India's domestic airline carriers (they rock!) but from the religious culture of acceptance (sans their views on Pakistan) and focus on family.
Of course, my American heart will be satisfied as soon as I can find some good bhindi masala and aloo gobhi.
Tuesday, May 8, 2007
Friday, May 4, 2007
Part of the ruins at Qutab Minar. Inside an ancient mosque. Actual post is below but I forgot to note that they have an iron pillar in the courtyard which has weathered a great deal and amazes metalurgists (sp?) everywhere. They say if you can stand with your back to it and put your arms around it behind you, your wildest dreams will come true. It has a fence though, and apparently where "wildest dreams" are available, I'm too lazy.
Delightful Delhi
OK, so this picture isn't Delhi- its Agra. But I'm a bit late and unskilled on the blogging. It is insanely hot in this picture and I'm wearing the brigtest clothing I own- shawl, pants, top all this crazy orange color! Its a salwar. At a very expensive boutique for Indian wedding clothing down the road from us in Delhi where we ventured in just to look, the lady said in a beautiful British accent, "My, you have bright clothing, even for India." She understood better when I said I had bought everything in South India- pretty much another country altogether.
The last few days in Delhi have been fun and relaxing. Our hotel is excellent- Jor Bagh 27 Guesthouse across from the Lodi Gardens.
It is a small place with only 11 rooms but one of the very few places in Delhi that is mid-range- western toilets but hot water debateable. It is in a small gated neighborhood peopled with Sikhs, Muslims, and expats for the most part. People have actual dogs here among the strays and a few small greens to sit in in the middle of the neighborhoods. The small market down the road boasts western foodstuffs (although very expensive) and there is a bookstore with English titles only. Across the road is the Lodi or Lodhi gardens which I described and several blocks away is Khan Market where we went today.
Khan Market is a small grouping of upscale shops where expats hang out. The Indians are extremely hip and wealthy and the expats are mostly old diplomats- German and English women. (I assume the men are working?) By the way, I have not met a single American since being in Delhi. Our little hotel has a few German businessmen and a few Australian tourists. But Americans are a pretty rare sight as far as white people go.
The shopping in Delhi is phenomenal. It is much more expensive than Chennai or Vellore, but much less expensive than the US. And the products are so diverse and beautiful- so much is handmade and unique. Generally speaking, its so hard to forgo shopping in a country where things are colorful and handmade and cost a fourth of the price. We went into a very upscale and expensive for Delhi standards home shop and the beautiful glasses and platters made in India were reminiscent of Anthropologie- the price, less than half that.
I didn't buy anything there, but I will say I am bringing home an extra piece of luggage. A duffel, all of $4.
Yesterday we also traveled to the Qutab Minar- a monument built by yet another Muslim shah- lovely mosques, the remnants of a college, and a large tower 73 m high which I had seen from the plane.
http://en.wikipedia.org/wiki/Qutab_Minar
It was a beautiful area, but Muslim architecture is wearing on me and it is remarkable how many amazing structures- including multiple tombs in the Lodi gardens were built by Sultans where Hindu kings left little.
When I get back I'll have a more clarified conclusion to India, but in the meantime, I want to express what a strange country and people it has. I am reading an excellent book helping me deal with some of the major contradictions. It is called "Holy Cow" by Sarah MacDonald and is very funny and dead-on with its observations of daily Indian life (at least from what I've seen) even down to her notation of the "sweaty feet" smell inside the Akbar's Mausoleum hallway on the way to the tomb. Exactly what I was thinking.
MacDonald travels through India learning about the major religions trying to come to peace with the crazy land. It is hard to understand how people so friendly can take major advantage of you without any conscience (not all the time, obviously, but much of the time). Or how a country that has shown major tolerance historically to multiple religions: Hindu, Muslim, Sikh, Parsi, Buddhist, Christianity... can also uphold a caste system (still very much in place) and value people with the lightest skin above all.
What country promotes sanctity of family life and children and at the same time commits major female infanticide and calmly justifies suicide for honor? A country where humanitarian groups are highly regarded and charity is blessed yet day to day life includes the killing of beggars by buses which leave them to die?
Ok, critics will note that every country has some contradictions. But India puts it all out there- in the wide open- all the time. The injustices are very visible and easily felt, as are the kindnesses. I have not seen a great many places, but I feel this place leaves me completely emotionally adrift in a way I did not experience in Europe, Africa, or Latin America.
Well, as one might sing at church youth camp: give it up to God.
Wednesday, May 2, 2007
Delhi rain!
So my batteries in my camera keep dying. I think its possible this camera is not meant for heat or something. It can eat two batteries in one day here.
I tried uploading Taj photos to this blog, but I couldn't get one before it died on me.
Again.
So sad. But did add a few to Snapfish.
Today it rained in Delhi. Wonderful cooling rain and wind made it a wonderful place to be. I walked to a nearby market area and had a salwar altered right on the street. I made motions to indicate how I wanted the sides taken in and sleeves put on and they loaded in green thread to their street front sewing machines and simply started. Afterwards, another man lay on the street ironing the salwar with a heavy piece of heated-on-fire iron.
This afternoon I visited the Lodi Garden- across from where we are staying as it was so mild and lightly raining. I was a little on edge because there were very few women and all hiding in the bushes with their dates (husbands)- not smooching, mind you, but embracing which is considered scandalous anyway. Or just holding hands (something you'd never ever see in public between men and women!) Mostly the park is filled with unemployed men loitering and resting on the monuments watching the hidden couples.
I imagine it would be hard and a boring life to be unemployed in India, sitting most of the hot day, waiting for mealtimes to collect some street snacks, returning home. Or not I guess as hundreds of people sleep right on the sidewalks every night- no coverings and not in doorways, but simply prostrate on street edges. This explains why when we come near a stand or open shop, or simply wake up in the morning, the men jump to attention and quickly and energetically proffer food or laundry.
Last night when we came in late, I was surprised to see several of the men who work at this small guesthouse sleeping in the plastic lawn chairs. The guard was understandable, but it hadn't occurred to me that these early rising hotel men were homeless and slept upright in terrible plastic chairs. I'm sure they are not allowed to lie on the grass and damage it.
Tomorrow, no agenda! Passing time in Delhi...
I tried uploading Taj photos to this blog, but I couldn't get one before it died on me.
Again.
So sad. But did add a few to Snapfish.
Today it rained in Delhi. Wonderful cooling rain and wind made it a wonderful place to be. I walked to a nearby market area and had a salwar altered right on the street. I made motions to indicate how I wanted the sides taken in and sleeves put on and they loaded in green thread to their street front sewing machines and simply started. Afterwards, another man lay on the street ironing the salwar with a heavy piece of heated-on-fire iron.
This afternoon I visited the Lodi Garden- across from where we are staying as it was so mild and lightly raining. I was a little on edge because there were very few women and all hiding in the bushes with their dates (husbands)- not smooching, mind you, but embracing which is considered scandalous anyway. Or just holding hands (something you'd never ever see in public between men and women!) Mostly the park is filled with unemployed men loitering and resting on the monuments watching the hidden couples.
I imagine it would be hard and a boring life to be unemployed in India, sitting most of the hot day, waiting for mealtimes to collect some street snacks, returning home. Or not I guess as hundreds of people sleep right on the sidewalks every night- no coverings and not in doorways, but simply prostrate on street edges. This explains why when we come near a stand or open shop, or simply wake up in the morning, the men jump to attention and quickly and energetically proffer food or laundry.
Last night when we came in late, I was surprised to see several of the men who work at this small guesthouse sleeping in the plastic lawn chairs. The guard was understandable, but it hadn't occurred to me that these early rising hotel men were homeless and slept upright in terrible plastic chairs. I'm sure they are not allowed to lie on the grass and damage it.
Tomorrow, no agenda! Passing time in Delhi...
Tuesday, May 1, 2007
Agra
We returned very late last night from Agra. We had a huge list of sites to see, but because of corrupt government taxi services, only managed three. Which was actually ok, because it was pretty hot and after you've seen the Taj, well... every other site seems lackluster.
We started at Akbar's Mausoleum, which was the best site in Agra. The grandfather of Shah Jahan (who built the Taj) was religiously "enlightened" and married many women of different faiths, incorporated their faiths into his own and founded his own religion- the name of which translates to "One God." He built a beautiful mausoleum surrounded by lawns on which antelope and apparently bison roam. We never saw the bison, however.
No one was there. We were some of a handful of tourists and the beautiful site with its lovely grounds had not yet reached 110 degress, so it was pretty nice.
Second, we traveled to the Red Fort to knock it out of the way before lunch. We did this fast- kept moving- cause of the serious heat, and our hunger (we'd gotten on a train at 6 AM and woken up at about 4). It is an impressive site and in much better condition than the Red Fort in Delhi. There are palaces inside- all open Moghul palaces with water running through (hypothetically. There is no water in the fountains or canals). Unfortunately, all signs were in Hindu so we were not sure what rooms were what although those signs might just as easily been explaining "stay off the steps" or "no urinating."
After lunch we were hassled for several hours before we saw the Taj. There were more people than we've seen at any sites, although it must be a fraction of the numbers during decent seasons. The site is beautiful and well kept (of course, its actually pretty new by European standards). We were supposed to swoon over the love story and complied.
There were more white people than I've seen in a month and I felt terrible for some parents of two small beautiful red-headed children (the ONLY white children I've seen this whole month) because rude Indians/Nepalese were grabbing them and demanding pictures with them. And the girl was crying and crying as women forced her head toward their husband's camera. The dad was saying "Oh, she's shy. Let her be. She's shy."
I would have hit them with their own cameras had that been my child.
Luckily, it appeared they were with a cruise or tour or something, so this may have been their only Indian experience.
The Taj is amazing because it is surrounded by all that is rural India. Directly behind the Taj on the banks of a river are camels sitting and naked children swimming. Monkeys climbed the wall and were seeking shade under benches.
Anyways, I could go into the major hassling we experienced, but you can ask me personally. I had to go into super high octane bitch mode getting off trains, into cars, walking, breathing. And be forceful and throw several fits during the day over many things hindering our having a safe travel.
At the same time, we are constantly told by men that we are not safe. And there is a culture of "can I take you where you need to go, madame" blah blah. While there is some danger, I actually think alot of the information is truly paternalistic propaganda, designed to intimidate women and, thus, provide jobs for men. Women here are scared to do anything alone, and we threaten that system by flaunting our married independence. We are collectively sick of being told what, how, when to do everything by men with "our best interests" in mind.
OK, that's all for now! I'm sorry about no photos. I may try later!!
We started at Akbar's Mausoleum, which was the best site in Agra. The grandfather of Shah Jahan (who built the Taj) was religiously "enlightened" and married many women of different faiths, incorporated their faiths into his own and founded his own religion- the name of which translates to "One God." He built a beautiful mausoleum surrounded by lawns on which antelope and apparently bison roam. We never saw the bison, however.
No one was there. We were some of a handful of tourists and the beautiful site with its lovely grounds had not yet reached 110 degress, so it was pretty nice.
Second, we traveled to the Red Fort to knock it out of the way before lunch. We did this fast- kept moving- cause of the serious heat, and our hunger (we'd gotten on a train at 6 AM and woken up at about 4). It is an impressive site and in much better condition than the Red Fort in Delhi. There are palaces inside- all open Moghul palaces with water running through (hypothetically. There is no water in the fountains or canals). Unfortunately, all signs were in Hindu so we were not sure what rooms were what although those signs might just as easily been explaining "stay off the steps" or "no urinating."
After lunch we were hassled for several hours before we saw the Taj. There were more people than we've seen at any sites, although it must be a fraction of the numbers during decent seasons. The site is beautiful and well kept (of course, its actually pretty new by European standards). We were supposed to swoon over the love story and complied.
There were more white people than I've seen in a month and I felt terrible for some parents of two small beautiful red-headed children (the ONLY white children I've seen this whole month) because rude Indians/Nepalese were grabbing them and demanding pictures with them. And the girl was crying and crying as women forced her head toward their husband's camera. The dad was saying "Oh, she's shy. Let her be. She's shy."
I would have hit them with their own cameras had that been my child.
Luckily, it appeared they were with a cruise or tour or something, so this may have been their only Indian experience.
The Taj is amazing because it is surrounded by all that is rural India. Directly behind the Taj on the banks of a river are camels sitting and naked children swimming. Monkeys climbed the wall and were seeking shade under benches.
Anyways, I could go into the major hassling we experienced, but you can ask me personally. I had to go into super high octane bitch mode getting off trains, into cars, walking, breathing. And be forceful and throw several fits during the day over many things hindering our having a safe travel.
At the same time, we are constantly told by men that we are not safe. And there is a culture of "can I take you where you need to go, madame" blah blah. While there is some danger, I actually think alot of the information is truly paternalistic propaganda, designed to intimidate women and, thus, provide jobs for men. Women here are scared to do anything alone, and we threaten that system by flaunting our married independence. We are collectively sick of being told what, how, when to do everything by men with "our best interests" in mind.
OK, that's all for now! I'm sorry about no photos. I may try later!!
Sunday, April 29, 2007
Red Fort and Lauren becomes a celebrity
Today we were determined to hit all the hot spots that were "far away" (read- 10 km) from our hotel. So our kind and quiet driver picked us up at nine, blasted the AC all day, and we took off for the
1. Red Fort- big fort, reddish, used to be whitish, seat of the Peacock throne Shah Jahan (maker of Taj as well). Most of the marble inlay has been destroyed. Used for picnicking Indian families. Good example of Moghul architecture.
2. Jama Masjid- largest mosque in a quarter hemisphere or something like that. Large stone flooring ready to give us second degree burns since we have to take off shoes. Beautiful but very hot.
3. Raj Ghat- where Gandhi was cremated. A large slab. As we come down the hill from the viewpoint area, we witness Lauren being attacked by Nepalese tourists wearing the hats they sell for crazy prices at the Fort. They are taking pictures with her, one by one, seated, standing, pictures with them shaking her hand, etc... Literally, her face will be in a hundred Nepalese picture books.
4. Cottage Industries- the fair trade, government run, Indian crafts store. Although turns out to be more large expensive handwoven carpets and beautiful gold jewelry. But the quality of the products was undisputedly superior to anything we've seen. The wedding outfits of which they had many looked straight off a Bollywood set.
5. Lunch- we asked our driver for Indian food, somewhere air conditioned where we wouldn't get ill. We don't know how much English he has but he took us straight to Splash! restaurant also listed as one of the 5 hip places in Delhi in their magazines. We fought to order our expensive ($4 entree) Indian food before an entire table of drunk Germans could. Every foreigner in New Delhi was there- and we know, because we saw them all that morning at the Red Fort. We feel so poor now- in Vellore our lunches cost 50 cents!
6. India Gate- memorial to WWI- only requires taking pictures. I was angry at a man trying to sell us baby monkeys on leashes. Cruel and common here.
7. The National Museum- we took the audio tour.
Here, I will explain why India lags behind in tourism. I guess in list form.
1. Old Delhi is very unpleasant due to touts. Constant clutching of the purse and men haranguing you- even if you say NO! emphatically and walk past, they will obstruct your view or way in order to sell their services as a driver, their hats, fans, etc... hanging on your arm, pulling your pants. I have made it a policy not to go in shops where we are taken or harassed to enter and never to buy anything from a tout. Not because I can discourage this behavior, but because it is simply my money to spend and I want to reward the shop keepers who do not use these tactics.
2. When driving in the car, many will hold up babies and bang bang on the windows asking for money. It is easy for me to avoid pitying this or having a crisis of conscience because they are using an innocent baby as blackmail which in anyone's book is wrong. This maneuver is common to all Indian cities, but more prevelent in Old Delhi (so I've been told)
3. The sites are falling apart. It is amazing when the symbol of a nation has overgrown weeds filling copious courtyards or has a guard leaning absurdly against a tremulous and delicate ivory grate.
4. No official guidebooks are for sale. The government allows the touts with postcards and guidebooks in, but no official store or place to garner infomation or spend money that might restore the place.
5. Many men ouside monuments claiming charges that aren't necessary. (we kinda wait and watch and if others pass by them without paying, then we charge in) And tourism police watch this go on. Men who are not employed in any official capacity hanging in the bathrooms asking for tips before you can use the dirty squat toilet they don't clean. Its a good racket.
6. The museum was surprising in its lack of modernity. AC in only one room-old documents- and was conducted in by an ancient fan from a hole cut into the ceiling. Looked like the Peabody Museum at Harvard with labels that were antiquities themselves and chairs and tables placed in front of exhibits for no reason other than the guards like sitting where a fan blows- amazing for a National Museum!!
They had some interesting artifacts and tribal costumes. Beautiful textiles, if fairly new. I learned a little more about the pantheon of Hindu gods. The museum store had various random things, completely unrelated to the content of the collection, and no books about the collection. Only books about how to draw and how to make a healthy marriage.
It was about 100 degrees in there anyhow.
1. Red Fort- big fort, reddish, used to be whitish, seat of the Peacock throne Shah Jahan (maker of Taj as well). Most of the marble inlay has been destroyed. Used for picnicking Indian families. Good example of Moghul architecture.
2. Jama Masjid- largest mosque in a quarter hemisphere or something like that. Large stone flooring ready to give us second degree burns since we have to take off shoes. Beautiful but very hot.
3. Raj Ghat- where Gandhi was cremated. A large slab. As we come down the hill from the viewpoint area, we witness Lauren being attacked by Nepalese tourists wearing the hats they sell for crazy prices at the Fort. They are taking pictures with her, one by one, seated, standing, pictures with them shaking her hand, etc... Literally, her face will be in a hundred Nepalese picture books.
4. Cottage Industries- the fair trade, government run, Indian crafts store. Although turns out to be more large expensive handwoven carpets and beautiful gold jewelry. But the quality of the products was undisputedly superior to anything we've seen. The wedding outfits of which they had many looked straight off a Bollywood set.
5. Lunch- we asked our driver for Indian food, somewhere air conditioned where we wouldn't get ill. We don't know how much English he has but he took us straight to Splash! restaurant also listed as one of the 5 hip places in Delhi in their magazines. We fought to order our expensive ($4 entree) Indian food before an entire table of drunk Germans could. Every foreigner in New Delhi was there- and we know, because we saw them all that morning at the Red Fort. We feel so poor now- in Vellore our lunches cost 50 cents!
6. India Gate- memorial to WWI- only requires taking pictures. I was angry at a man trying to sell us baby monkeys on leashes. Cruel and common here.
7. The National Museum- we took the audio tour.
Here, I will explain why India lags behind in tourism. I guess in list form.
1. Old Delhi is very unpleasant due to touts. Constant clutching of the purse and men haranguing you- even if you say NO! emphatically and walk past, they will obstruct your view or way in order to sell their services as a driver, their hats, fans, etc... hanging on your arm, pulling your pants. I have made it a policy not to go in shops where we are taken or harassed to enter and never to buy anything from a tout. Not because I can discourage this behavior, but because it is simply my money to spend and I want to reward the shop keepers who do not use these tactics.
2. When driving in the car, many will hold up babies and bang bang on the windows asking for money. It is easy for me to avoid pitying this or having a crisis of conscience because they are using an innocent baby as blackmail which in anyone's book is wrong. This maneuver is common to all Indian cities, but more prevelent in Old Delhi (so I've been told)
3. The sites are falling apart. It is amazing when the symbol of a nation has overgrown weeds filling copious courtyards or has a guard leaning absurdly against a tremulous and delicate ivory grate.
4. No official guidebooks are for sale. The government allows the touts with postcards and guidebooks in, but no official store or place to garner infomation or spend money that might restore the place.
5. Many men ouside monuments claiming charges that aren't necessary. (we kinda wait and watch and if others pass by them without paying, then we charge in) And tourism police watch this go on. Men who are not employed in any official capacity hanging in the bathrooms asking for tips before you can use the dirty squat toilet they don't clean. Its a good racket.
6. The museum was surprising in its lack of modernity. AC in only one room-old documents- and was conducted in by an ancient fan from a hole cut into the ceiling. Looked like the Peabody Museum at Harvard with labels that were antiquities themselves and chairs and tables placed in front of exhibits for no reason other than the guards like sitting where a fan blows- amazing for a National Museum!!
They had some interesting artifacts and tribal costumes. Beautiful textiles, if fairly new. I learned a little more about the pantheon of Hindu gods. The museum store had various random things, completely unrelated to the content of the collection, and no books about the collection. Only books about how to draw and how to make a healthy marriage.
It was about 100 degrees in there anyhow.
Delhi
Our flight from Chennai to Delhi was on Jet Airways- a small domestic Indian carrier and was awesome. This is how flights should be in the U.S. Checking in was easy, going through security was easy (everyone gets hit by the small metal detectors), sitting in the gate was easy, getting on the plane was easy, getting a lovely meal was easy with real napkins and silverware, getting off was super easy with two exits to large buses, getting luggage took <6 minutes.
And the flight cost maybe a fourth of what it would in the US. There were twice as many flight attendants as well. I'm not sure how many flight attendants=one tank of fuel. But I'm sure that ratio decreases in the U.S.
At any rate, we arrived, found the official government stand (the non-official kinda govt stands look similar though!) and got a taxi and car for the next day. The difference between taking a non AC tour and hiring an AC car for an entire day is about $1. But our perceptions are so warped at this point we actually argued about this for 10 minutes.
Delhi is nothing like Chennai. Granted, we are staying in a lovely area. Really beautiful for India. Delhi has the urban markets, the bazaars- they are mostly near Old Delhi- and they are similar to all parts of Vellore. But Vellore and Chennai do not have the diplomatic and international green areas which look like affluent areas of Europe. There are rows of embassies and governmnt buildings surrounded by green and tree-lined streets. The streets have little littering- mostly only around the occasional snack stands- and are easily drive-able.
We are staying in a small guest house near Lodi Gardens- in a gated neighborhood called "Jor Bagh." The neighborhood has a few small parks (no cricketeers on pain of death!), dogs with actual collars and full bellies!, and international looking expats walking strollers. This is where I would love to live in Delhi. The houses are still modest, but clearly an upper class neighborhood. We found a store in "Jor Bagh Market" called Lal and sons popular with expats for christmas ornaments. And that they have. The old man running it talked with usfor a long time and was very excited to show us his listing in the Lonely Planet. He is the only listing in this part of town.
Every morning I have coffee and its black! Interestingly, the housemen here like to move me around. When I wake up and ask for coffee they first move me to the garden area, then as I go to get my book, they move my coffee to this courtyard sort of slab thing. Then they are anxious to make me go to the little room they use as a dining room.
I just want to sit and read!
We had a wonderful dinner (primarily because it included fish which Lauren and I needed) at the Lodi Garden restaurant. We were the only people in this huge (most expensive restaurant in Delhi, apparently which means my mixed seafood grille cost $12) place because no one hip enough to be seen there eats until 10. This we did not know. Which means we are in no way hip. But our food came fast!
And the flight cost maybe a fourth of what it would in the US. There were twice as many flight attendants as well. I'm not sure how many flight attendants=one tank of fuel. But I'm sure that ratio decreases in the U.S.
At any rate, we arrived, found the official government stand (the non-official kinda govt stands look similar though!) and got a taxi and car for the next day. The difference between taking a non AC tour and hiring an AC car for an entire day is about $1. But our perceptions are so warped at this point we actually argued about this for 10 minutes.
Delhi is nothing like Chennai. Granted, we are staying in a lovely area. Really beautiful for India. Delhi has the urban markets, the bazaars- they are mostly near Old Delhi- and they are similar to all parts of Vellore. But Vellore and Chennai do not have the diplomatic and international green areas which look like affluent areas of Europe. There are rows of embassies and governmnt buildings surrounded by green and tree-lined streets. The streets have little littering- mostly only around the occasional snack stands- and are easily drive-able.
We are staying in a small guest house near Lodi Gardens- in a gated neighborhood called "Jor Bagh." The neighborhood has a few small parks (no cricketeers on pain of death!), dogs with actual collars and full bellies!, and international looking expats walking strollers. This is where I would love to live in Delhi. The houses are still modest, but clearly an upper class neighborhood. We found a store in "Jor Bagh Market" called Lal and sons popular with expats for christmas ornaments. And that they have. The old man running it talked with usfor a long time and was very excited to show us his listing in the Lonely Planet. He is the only listing in this part of town.
Every morning I have coffee and its black! Interestingly, the housemen here like to move me around. When I wake up and ask for coffee they first move me to the garden area, then as I go to get my book, they move my coffee to this courtyard sort of slab thing. Then they are anxious to make me go to the little room they use as a dining room.
I just want to sit and read!
We had a wonderful dinner (primarily because it included fish which Lauren and I needed) at the Lodi Garden restaurant. We were the only people in this huge (most expensive restaurant in Delhi, apparently which means my mixed seafood grille cost $12) place because no one hip enough to be seen there eats until 10. This we did not know. Which means we are in no way hip. But our food came fast!
Thursday, April 26, 2007
I am sad as we leave Vellore to be discovering new things about the city near the end. In some respects, the heat has hampered our ability to fully explore and walk over the whole city. The last few days, it has been >105 F. There are places we pass in rickshaws which I had hoped to discover, but cannot find later or cannot direct another rickshaw adequately. Its hard when signs are in Tamil and the driver only speaks Tamil so describing the produce or products seen fleetingly in a window is impossible.
This morning we went back to the eyebrow-threading "ladies station." The many women working there wear orange saris and the one skilled in beauty waxed my lower legs for 70 Rs. Bharvi was having it done so I joined in. We first said a prayer to a panel of gods and active incense. Then we were fed small bits of orange sweetness- an after prayer breakfast sweet. It was very nice and not painful at all- which is probably because my hair needs more serious wax- its too fine I guess.
Anyways, a good way to start the morning and we are at the internet place early early.
This morning we went back to the eyebrow-threading "ladies station." The many women working there wear orange saris and the one skilled in beauty waxed my lower legs for 70 Rs. Bharvi was having it done so I joined in. We first said a prayer to a panel of gods and active incense. Then we were fed small bits of orange sweetness- an after prayer breakfast sweet. It was very nice and not painful at all- which is probably because my hair needs more serious wax- its too fine I guess.
Anyways, a good way to start the morning and we are at the internet place early early.
the last days at Vellore...
To get a good deal on airline tickets (they're really cheap domestic unless you want a non-sketchy airline with actual seats), we had to buy our tickets for saturday- day after tomorrow! At this point we have seen alot and feel pretty ready for a move or home. So the move to Delhi. How will we spend a whole week in Delhi? Of course, traveling to Agra to see the Taj will require a full day on the train, but otherwise, we only have enough sites for two days...
I wish we could fly back to the US a few days earlier. We in fact investigated this, but all flights were full. Plus, Delhi will be much more expensive- a bit like staying in a cheap motel in the US for a week, but quite alot for a budget hotel in India. I hope there are not squat toilets!
In the last few days we've heard of locals having very bad experiences with rude Americans from UTHSCSA. Some have encountered us with distrust and misgivings and after developing a relationship they have become more personable and kind. Simply because they have been treated with disrespect by other students from San Antonio. I have also heard from the accountants that several students did not pay the $100 fee to the hospital.
Not to get on my soapbox, but I wanted to write to inform the Brand Scholarship program that it may be a good idea to interview students as a part of their application. I know, I know... this probably won't help exclude the rude students who come and feel entitled to American privilege. But maybe it would discourage those who do not wish to learn and consider their trip to India to be a mission in which they educate and establish superiority. We have learned far more from the health care workers, restauranteurs and hotel staff here than we could have taught them. The girls I'm traveling with are as disappointed as I am to need to apologize for some of the students who have and are participating in this program.
A lighter topic...
Bangle Mania!!
We sought out a bangle shop out of the myriad bazaar streets. In India, streets are themed. There are silk streets, auto part streets, milk container streets, large welded greasy ring thing streets, and, yes, Bangle Boulevard.
The first shop told us they sold only wholesale. The second shop, also filled with large boxes, looked the same, sold anything.
I actually abstained from the mania which followed because I wasn't sure I wanted bangles as gifts, but the comparison of colors, glass, gold, etc.. was entertaining.
As yesterday the other girls came back to the hotel late late late after getting lost on the #2 bus, we decided today would be hospital-lite. Basically, Bharvi summed it up as she hung her head on the back of the seat in front, even as Lauren squealed over the monkeys, saying "I think I am going to die. I cannot survive another single day of medical school."
The Jeep driver had looked concerned about their health, and after this scene was recreated in the hotel and our kidneys kicked back into gear by the night having been tragically depleted of fluid for an entire day, we decided on bangles instead of blinding heat, sweaty shopping instead of swamp-thing-like survival. Monkeys and antenatal clinic be damned. The white people melted. (plus Bharvi)
BTW, we saw a very old man today with a 2 foot trident stuck through his tongue. He also had a white lunghi and lots of ash (painted ash from the temples) all over his crazy white head.
awesome.
also sighted: very black veiled Muslim women with secret bangles underneath buying more super-secret bangles.
Did I write yesterday about the dog? As we ate lunch a sweet looking dog was crying for our food, and I saved all these little scraps thinking I would sneak them to him when no one was looking. Few dogs in these parts cry or vocalize at all- this guy was the most personable I've seen. Funny thing was, when we were done, the health aide at whose house we were eating, took my scraps and as I worried she would toss them, added my scraps to the others and actually fed the dog!!
I was so gratified, poor little thing, covered in mites.
I wish we could fly back to the US a few days earlier. We in fact investigated this, but all flights were full. Plus, Delhi will be much more expensive- a bit like staying in a cheap motel in the US for a week, but quite alot for a budget hotel in India. I hope there are not squat toilets!
In the last few days we've heard of locals having very bad experiences with rude Americans from UTHSCSA. Some have encountered us with distrust and misgivings and after developing a relationship they have become more personable and kind. Simply because they have been treated with disrespect by other students from San Antonio. I have also heard from the accountants that several students did not pay the $100 fee to the hospital.
Not to get on my soapbox, but I wanted to write to inform the Brand Scholarship program that it may be a good idea to interview students as a part of their application. I know, I know... this probably won't help exclude the rude students who come and feel entitled to American privilege. But maybe it would discourage those who do not wish to learn and consider their trip to India to be a mission in which they educate and establish superiority. We have learned far more from the health care workers, restauranteurs and hotel staff here than we could have taught them. The girls I'm traveling with are as disappointed as I am to need to apologize for some of the students who have and are participating in this program.
A lighter topic...
Bangle Mania!!
We sought out a bangle shop out of the myriad bazaar streets. In India, streets are themed. There are silk streets, auto part streets, milk container streets, large welded greasy ring thing streets, and, yes, Bangle Boulevard.
The first shop told us they sold only wholesale. The second shop, also filled with large boxes, looked the same, sold anything.
I actually abstained from the mania which followed because I wasn't sure I wanted bangles as gifts, but the comparison of colors, glass, gold, etc.. was entertaining.
As yesterday the other girls came back to the hotel late late late after getting lost on the #2 bus, we decided today would be hospital-lite. Basically, Bharvi summed it up as she hung her head on the back of the seat in front, even as Lauren squealed over the monkeys, saying "I think I am going to die. I cannot survive another single day of medical school."
The Jeep driver had looked concerned about their health, and after this scene was recreated in the hotel and our kidneys kicked back into gear by the night having been tragically depleted of fluid for an entire day, we decided on bangles instead of blinding heat, sweaty shopping instead of swamp-thing-like survival. Monkeys and antenatal clinic be damned. The white people melted. (plus Bharvi)
BTW, we saw a very old man today with a 2 foot trident stuck through his tongue. He also had a white lunghi and lots of ash (painted ash from the temples) all over his crazy white head.
awesome.
also sighted: very black veiled Muslim women with secret bangles underneath buying more super-secret bangles.
Did I write yesterday about the dog? As we ate lunch a sweet looking dog was crying for our food, and I saved all these little scraps thinking I would sneak them to him when no one was looking. Few dogs in these parts cry or vocalize at all- this guy was the most personable I've seen. Funny thing was, when we were done, the health aide at whose house we were eating, took my scraps and as I worried she would toss them, added my scraps to the others and actually fed the dog!!
I was so gratified, poor little thing, covered in mites.
Wednesday, April 25, 2007
Nursing Rounds
OK, first another correction. The "health dates" are really "health aides"- would make sense, right? About a million people said it to me and I heard "dates" everytime.
Nursing rounds today was arduous. Very. It is so amazingly hot in these villages and the finite time in the Jeep with the windows down was not enough. I kept thinking over the early signs of heat stroke. Add to that my disinclination to drink too much water since I had no idea when or where we might stop, if ever, for a bathroom.
But we caught onto a lot of interesting stories, dramatic many of them, as the nurse and a health aide- one for each two villages- were driven around to see patients. We went into homes for most patients except a few who ran up to the jeep looking for meds. These were antenatal appts- women who had pink cards like our yellow ones at home with each antenatal visit information, BP, edema, urine, fundal height, etc... No serologies.
The homes were interesting as some seemed quite remote but would have electricity (ie: a fan or light bulb). Others did not have electricity and most were one or two rooms, a mud hut with low thatch roof. No beds inside- possibly a cot, but mostly mats for the dirt floor. They would roll out the mats for us to sit on and for the pregnant woman's exam. Men vacated quickly and the sari was undone to feel for baby placement and auscultate heart rate. After this the nurse when through a litany of "If you feel ___, come to CHAD hospital immediately. If ___ happens, do not worry but report as soon as possible..." That speech in any language sounds the same.
At some houses we received snacks- a banana or chocolate candy off a tray once! After I took pictures of lots of coconut spread out to dry, we were given whole bits of coconut to eat.
Some of the villages required walking across several fields and around quarries. The nurse and aide had umbrellas and looked quite picturesque in their white blue and pink sarees. I wore an ugly orange hat and scared small children. Plus I was sweating like you've never seen and they had a bit of glisten which they blotted with handkerchiefs.
BTW, I did not get many pictures because despite buying a whole second new set of batteries, they were dead! The package had not been tampered, but India is so hot all the batteries die in transport. I have wasted alot of money so far. This afternoon I am going to desperately look in the cooler stores for brand new batteries. Or no one will see pictures of the Taj and I will cry.
At one village we stopped at about 4 houses trying to document the cause of death of a man living there. Everyone seemed to have lots to say about it and the small enclave in the middle of the village had a crowd which gathered to watch the man's son take on his spirit. This guy was dressed in a white lunghi and was careening around the crowd yelling and yelling. He then whooped, convulsed, and fainted. We were told he had taken on his father's spirit and was communicating his wishes. Or something. Who needs speaking in tongues?
We stopped at several houses to coo for a good half hour over babies. The health aide and the nurse at the last villages were very chummy and were having a great time. They felt sorry for me as I looked like death and didn't understand ANYTHING going on and bought me a 7 UP. Then made fun of me because I couldn't finish it quickly enough. My belly was all bubbles. Too hot to eat anything either.
So, a lot of gossip later we went to a house where an old woman without any teeth was kind of hysterical and we waited with the cows while she and a few others chased after an old man down a creekbed. Turns out, he had attempted suicide because he believed his wife (the hysterical woman) was cheating on him and had rope burns all over his face and neck. They were urging him to go to the hospital. Wasn't happening. So we left the health aide there to call if she could get him to come and took off at long last back to CHAD.
Additionally, we met several PITCHWs who were very old. One followed us- a very small, toothless woman- around a village and joked with the nurse. She had trouble with the nurse's name "Clara" saying "Cavida" instead. We spent alot of time lunching on the health aide's porch with this lively old woman. After Illeana and I took her picture she started crying and crying. The nurse translated that the PITCHW's husband had died 40 years ago and the mites had eaten her only picture of him.
The PITCHW also told us that she married before menarche and had to wait 2 years before moving into her in-law's house. She married with a veil and never saw her husband until two years after the ceremony.
I bought some sandals like the ones the PITCHW was wearing and have now seen several old woman in them. I guess I buy old lady shoes here. I'm sorry about the lack of pictures. The guy at the internet place just shakes his head at me everytime I bring my card! I think he's tired of us downloading pictures since it takes so long.
I will expand the "everyone knows what we are doing at any moment in time" to include rickshaw drivers. I walk up and a dude I've never seen is like "Darling residency?" He knows!!
And they also know not to actually stop at Darling since we aren't staying there but use it as our stop for the internet place. HOW, I ask you? There are only a hundred of them, but they know...
Yesterday, I was peeved when our driver stopped the rickshaw to talk on his phone. Lauren pointed out optimistically that this was the safest thing to do, ignoring the irony that we were sitting on each other's laps without seatbelts on a three-wheeled diesel contraption with the battery under our feet. But oooo do I love rickshaws.
Nursing rounds today was arduous. Very. It is so amazingly hot in these villages and the finite time in the Jeep with the windows down was not enough. I kept thinking over the early signs of heat stroke. Add to that my disinclination to drink too much water since I had no idea when or where we might stop, if ever, for a bathroom.
But we caught onto a lot of interesting stories, dramatic many of them, as the nurse and a health aide- one for each two villages- were driven around to see patients. We went into homes for most patients except a few who ran up to the jeep looking for meds. These were antenatal appts- women who had pink cards like our yellow ones at home with each antenatal visit information, BP, edema, urine, fundal height, etc... No serologies.
The homes were interesting as some seemed quite remote but would have electricity (ie: a fan or light bulb). Others did not have electricity and most were one or two rooms, a mud hut with low thatch roof. No beds inside- possibly a cot, but mostly mats for the dirt floor. They would roll out the mats for us to sit on and for the pregnant woman's exam. Men vacated quickly and the sari was undone to feel for baby placement and auscultate heart rate. After this the nurse when through a litany of "If you feel ___, come to CHAD hospital immediately. If ___ happens, do not worry but report as soon as possible..." That speech in any language sounds the same.
At some houses we received snacks- a banana or chocolate candy off a tray once! After I took pictures of lots of coconut spread out to dry, we were given whole bits of coconut to eat.
Some of the villages required walking across several fields and around quarries. The nurse and aide had umbrellas and looked quite picturesque in their white blue and pink sarees. I wore an ugly orange hat and scared small children. Plus I was sweating like you've never seen and they had a bit of glisten which they blotted with handkerchiefs.
BTW, I did not get many pictures because despite buying a whole second new set of batteries, they were dead! The package had not been tampered, but India is so hot all the batteries die in transport. I have wasted alot of money so far. This afternoon I am going to desperately look in the cooler stores for brand new batteries. Or no one will see pictures of the Taj and I will cry.
At one village we stopped at about 4 houses trying to document the cause of death of a man living there. Everyone seemed to have lots to say about it and the small enclave in the middle of the village had a crowd which gathered to watch the man's son take on his spirit. This guy was dressed in a white lunghi and was careening around the crowd yelling and yelling. He then whooped, convulsed, and fainted. We were told he had taken on his father's spirit and was communicating his wishes. Or something. Who needs speaking in tongues?
We stopped at several houses to coo for a good half hour over babies. The health aide and the nurse at the last villages were very chummy and were having a great time. They felt sorry for me as I looked like death and didn't understand ANYTHING going on and bought me a 7 UP. Then made fun of me because I couldn't finish it quickly enough. My belly was all bubbles. Too hot to eat anything either.
So, a lot of gossip later we went to a house where an old woman without any teeth was kind of hysterical and we waited with the cows while she and a few others chased after an old man down a creekbed. Turns out, he had attempted suicide because he believed his wife (the hysterical woman) was cheating on him and had rope burns all over his face and neck. They were urging him to go to the hospital. Wasn't happening. So we left the health aide there to call if she could get him to come and took off at long last back to CHAD.
Additionally, we met several PITCHWs who were very old. One followed us- a very small, toothless woman- around a village and joked with the nurse. She had trouble with the nurse's name "Clara" saying "Cavida" instead. We spent alot of time lunching on the health aide's porch with this lively old woman. After Illeana and I took her picture she started crying and crying. The nurse translated that the PITCHW's husband had died 40 years ago and the mites had eaten her only picture of him.
The PITCHW also told us that she married before menarche and had to wait 2 years before moving into her in-law's house. She married with a veil and never saw her husband until two years after the ceremony.
I bought some sandals like the ones the PITCHW was wearing and have now seen several old woman in them. I guess I buy old lady shoes here. I'm sorry about the lack of pictures. The guy at the internet place just shakes his head at me everytime I bring my card! I think he's tired of us downloading pictures since it takes so long.
I will expand the "everyone knows what we are doing at any moment in time" to include rickshaw drivers. I walk up and a dude I've never seen is like "Darling residency?" He knows!!
And they also know not to actually stop at Darling since we aren't staying there but use it as our stop for the internet place. HOW, I ask you? There are only a hundred of them, but they know...
Yesterday, I was peeved when our driver stopped the rickshaw to talk on his phone. Lauren pointed out optimistically that this was the safest thing to do, ignoring the irony that we were sitting on each other's laps without seatbelts on a three-wheeled diesel contraption with the battery under our feet. But oooo do I love rickshaws.
Monday, April 23, 2007
a quick trip to Kashmir
ha!
no we did not go to Kashmir!
but we did finally give in to temptation and pay 30 Rs. for a mini-pilgrimage up pretend Kashmir mountains. And met monsoon on the way down.
A large giant mountain was created out of papier mache and they have plasticky characters of pilgrims, deers, monkeys and soldiers with AK47s and then at turns incense and all sorts of Hindu gods surrounded by worshipful papier mache elephants. Forgive my ignorance for not knowing the stories very well. We have Bharvi to explain at every turn who this is and what they do, but I didn't write them down to rehash later!
Of course, as with everything here, it must be done barefoot even through a fountain and mock-Ganges river! At the end we came upon a large ice sculpture in a cold room and the men were yelling for donations and throwing rice at us (apparently to eat). The ice sculpture is Krishna incarnated as war- it was really like a large bullet of ice. Supposed to be like a "sheath."
As we came out of the room to descend the large mountain (probably three- four stories high), it started POURING. Crazy rain, and everyone backed up into the room as we ran ran ran down the mountain.
We went to the shoe storage and the boys inside screamed at us in Tamil- apparently things like "you big white idiots! seek shelter and wait for the rain to be over!" Everyone at the carnival surrounding this new year's mountain were huddled under food stands- they sure weren't going to waste their 30 Rs tickets by running home!
But we were all too willing to sacrifice those 50 cents and take a rickshaw out of there without seeing the rides.
no we did not go to Kashmir!
but we did finally give in to temptation and pay 30 Rs. for a mini-pilgrimage up pretend Kashmir mountains. And met monsoon on the way down.
A large giant mountain was created out of papier mache and they have plasticky characters of pilgrims, deers, monkeys and soldiers with AK47s and then at turns incense and all sorts of Hindu gods surrounded by worshipful papier mache elephants. Forgive my ignorance for not knowing the stories very well. We have Bharvi to explain at every turn who this is and what they do, but I didn't write them down to rehash later!
Of course, as with everything here, it must be done barefoot even through a fountain and mock-Ganges river! At the end we came upon a large ice sculpture in a cold room and the men were yelling for donations and throwing rice at us (apparently to eat). The ice sculpture is Krishna incarnated as war- it was really like a large bullet of ice. Supposed to be like a "sheath."
As we came out of the room to descend the large mountain (probably three- four stories high), it started POURING. Crazy rain, and everyone backed up into the room as we ran ran ran down the mountain.
We went to the shoe storage and the boys inside screamed at us in Tamil- apparently things like "you big white idiots! seek shelter and wait for the rain to be over!" Everyone at the carnival surrounding this new year's mountain were huddled under food stands- they sure weren't going to waste their 30 Rs tickets by running home!
But we were all too willing to sacrifice those 50 cents and take a rickshaw out of there without seeing the rides.
Continued CHAD
The story of CHAD continued...
The Dais- or midwives- were traditionally of the lower caste and specifically, the Barber's wife.
It is fascinating that in multiple cultures barbers evolved into the first surgeons independently. She probably had access to the knives.
At any rate, a Dais passed her trade on to her oldest daughter in law (since her own daughters would be married into other families). In any given village there would also be a "medicine man-" someone to be revered and feared who had supernatural powers and a link to the gods.
CHAD's mission starting in the 50s was to reach these remote villages- there are so many! - and train medical workers to continue birthing in homes, treating in situ. Dais were recruited to come to CHAD hospital and get certification and training- they apparently responded very positively as they received free of charge official tags, uniforms, sterilized kits and instruments, supplies of gloves.
It is amazing that the ancient practice of cutting the cord with a rusty knife and closing the umbilicus with cow dung was eradicated so easily in s. India simply by giving these Dais formal training, respect and dignity. The CHAD program calls them "Pitchews" or PITCHW (part time comm. health worker)
The "medicine men" were another issue. CHAD did not want antagonism or wasted resources so invited the medicine men to be "consultants" with once-monthly reports. Apparently since the 60s these men have come to CHAD once a month to have a conference, have been universally ignored except by drs. required to attend and spend alot of time whooping and hollering and "making nuisance." (nuisance making is a big crime in these parts)
In the last five years the government has mandated that all deliveries take place in a hospital. This is to cut down on rates of infanticide (it is also illegal to tell a couple a baby's sex by ultrasound). Thus, the "pitchews" practice more rarely in homes and instead work in rural hospitals and have ceased passing the practice to daughters in law.
In a quest for better records, CHAD has relied on the magic number 3 and hires one "health date" from each village for every 3 "pitchews," one nurse for every 3 "health dates" and one MD for every nurse.
The "health dates" are young girls who come for statistic training from the villages and wear pink saris. They are easily identifiable. They use GPS (as far as the military will let them) to record every single family member in every single cottage in every single little tribe. And they update monthly.
CODES
We also learned about a program CODES run by CHAD. Average rainfall is 900 mm a year- most farmers grow small crops of peanuts in the plains surrounding Vellore. Codes provides a secondary income for women to supplement their husband's farming as they travel to town daily for supplies. Interestingly, it was made clear to us that the organizers specifically wanted to avoid the fate of urban southern Africa where as women could get jobs in town, the men ceased to farm and sat on their lazy butts. Which is a vivid memory I have of Malawi- the women working constantly with mountains of supplies on their head while the men played on their bikes and sat eating sugarcane.
CODES mandates that the income be a second income if married. The women work by providing daycare for hospital workers children, adult daycare, counseling patients, welding equipment, embroidering and sewing hospital supplies (bedsheets, surgical gowns). And, maintaining the CMC pool of which we've heard the glories over and over (we need to go! its the place for all the foreign students to eat pizza!) We visited their work area and they were so so excited for pictures and made us promise to send them. I bought several wallets and purses they made to sell specifically to visitors.
Lastly, we've heard lately about the high rate of suicide among the elderly in the area. 12-14 per pop. 100,000 per month. The CHAD man informed us that this was due to more women getting jobs and taking husbands away from parents after the parents have divided their land and supplies among their sons. The women dislike that their salary gets dispersed among the whole paternal unit -to other sons and other son's wives, etc...
While it is likely that the elderly are suffering as tradition changes (the more astute are no longer dividing their land when their sons marry)- I don't know about the "evil wife" theory.
Guns are extremely rare and terrifically expensive here (more than a car) so these deaths are almost all hangings.
The adult daycare consists of locally grown food (no tea and cookies) and lots of gossip, as far as we can tell!
The Dais- or midwives- were traditionally of the lower caste and specifically, the Barber's wife.
It is fascinating that in multiple cultures barbers evolved into the first surgeons independently. She probably had access to the knives.
At any rate, a Dais passed her trade on to her oldest daughter in law (since her own daughters would be married into other families). In any given village there would also be a "medicine man-" someone to be revered and feared who had supernatural powers and a link to the gods.
CHAD's mission starting in the 50s was to reach these remote villages- there are so many! - and train medical workers to continue birthing in homes, treating in situ. Dais were recruited to come to CHAD hospital and get certification and training- they apparently responded very positively as they received free of charge official tags, uniforms, sterilized kits and instruments, supplies of gloves.
It is amazing that the ancient practice of cutting the cord with a rusty knife and closing the umbilicus with cow dung was eradicated so easily in s. India simply by giving these Dais formal training, respect and dignity. The CHAD program calls them "Pitchews" or PITCHW (part time comm. health worker)
The "medicine men" were another issue. CHAD did not want antagonism or wasted resources so invited the medicine men to be "consultants" with once-monthly reports. Apparently since the 60s these men have come to CHAD once a month to have a conference, have been universally ignored except by drs. required to attend and spend alot of time whooping and hollering and "making nuisance." (nuisance making is a big crime in these parts)
In the last five years the government has mandated that all deliveries take place in a hospital. This is to cut down on rates of infanticide (it is also illegal to tell a couple a baby's sex by ultrasound). Thus, the "pitchews" practice more rarely in homes and instead work in rural hospitals and have ceased passing the practice to daughters in law.
In a quest for better records, CHAD has relied on the magic number 3 and hires one "health date" from each village for every 3 "pitchews," one nurse for every 3 "health dates" and one MD for every nurse.
The "health dates" are young girls who come for statistic training from the villages and wear pink saris. They are easily identifiable. They use GPS (as far as the military will let them) to record every single family member in every single cottage in every single little tribe. And they update monthly.
CODES
We also learned about a program CODES run by CHAD. Average rainfall is 900 mm a year- most farmers grow small crops of peanuts in the plains surrounding Vellore. Codes provides a secondary income for women to supplement their husband's farming as they travel to town daily for supplies. Interestingly, it was made clear to us that the organizers specifically wanted to avoid the fate of urban southern Africa where as women could get jobs in town, the men ceased to farm and sat on their lazy butts. Which is a vivid memory I have of Malawi- the women working constantly with mountains of supplies on their head while the men played on their bikes and sat eating sugarcane.
CODES mandates that the income be a second income if married. The women work by providing daycare for hospital workers children, adult daycare, counseling patients, welding equipment, embroidering and sewing hospital supplies (bedsheets, surgical gowns). And, maintaining the CMC pool of which we've heard the glories over and over (we need to go! its the place for all the foreign students to eat pizza!) We visited their work area and they were so so excited for pictures and made us promise to send them. I bought several wallets and purses they made to sell specifically to visitors.
Lastly, we've heard lately about the high rate of suicide among the elderly in the area. 12-14 per pop. 100,000 per month. The CHAD man informed us that this was due to more women getting jobs and taking husbands away from parents after the parents have divided their land and supplies among their sons. The women dislike that their salary gets dispersed among the whole paternal unit -to other sons and other son's wives, etc...
While it is likely that the elderly are suffering as tradition changes (the more astute are no longer dividing their land when their sons marry)- I don't know about the "evil wife" theory.
Guns are extremely rare and terrifically expensive here (more than a car) so these deaths are almost all hangings.
The adult daycare consists of locally grown food (no tea and cookies) and lots of gossip, as far as we can tell!
CHAD history
I will write only a little about CHAD because I have tried to catch up on the weekend first.
I am sorry I don't have pictures- I wish I could upload more, but the internet place has not had a working drive for since last week.
A very nice man gave us a history lesson on CHAD and the CMC in general. His story was much embellished from the history provided on the CMC website which is already dramatic. Ida Scudder was an incredible woman. http://www.cmch-vellore.edu/pages/?id=scudder
Originally the CMC trained only women, but after independence in 1947 was required to train male drs. also. Ida Scudder's original philosophy was to train women to then head into the small tribal towns to treat people who did not know they were sick or did not know how to find help or could not afford care. She had never wanted to build a hospital, yet was compelled by wanting to provide specialized care. The first patients requiring hospitalization were housed in her home while she wrote specialists in the US to ask advice. The maximum the mail could take was 100 days so patients were hospitalized for exactly 100 days.
Dr. Scudder continued to travel by ox to villages daily during her entire life while simultaneously developing CHAD (comm health and development) and RUHSA hospitals. These hospitals were demanded by small tribes as a return for educating medical students on rural rotations about cultural practices.
The CMC main hospital currently has 2000 inpatients, 4000 outpatients, and 8000 staff present on any given day.
Most interesting was the discussion about Dais- or midwives and the integration of cultural healers into the expansion of the CMC medical mission. But I might need to leave this for tomorrow when I have more time.
I am sorry I don't have pictures- I wish I could upload more, but the internet place has not had a working drive for since last week.
A very nice man gave us a history lesson on CHAD and the CMC in general. His story was much embellished from the history provided on the CMC website which is already dramatic. Ida Scudder was an incredible woman. http://www.cmch-vellore.edu/pages/?id=scudder
Originally the CMC trained only women, but after independence in 1947 was required to train male drs. also. Ida Scudder's original philosophy was to train women to then head into the small tribal towns to treat people who did not know they were sick or did not know how to find help or could not afford care. She had never wanted to build a hospital, yet was compelled by wanting to provide specialized care. The first patients requiring hospitalization were housed in her home while she wrote specialists in the US to ask advice. The maximum the mail could take was 100 days so patients were hospitalized for exactly 100 days.
Dr. Scudder continued to travel by ox to villages daily during her entire life while simultaneously developing CHAD (comm health and development) and RUHSA hospitals. These hospitals were demanded by small tribes as a return for educating medical students on rural rotations about cultural practices.
The CMC main hospital currently has 2000 inpatients, 4000 outpatients, and 8000 staff present on any given day.
Most interesting was the discussion about Dais- or midwives and the integration of cultural healers into the expansion of the CMC medical mission. But I might need to leave this for tomorrow when I have more time.
Nayagara
Before I start, I want to apologize for misspelling "sarees" as "saris." There are no signs here and I realized when in the big city this weekend!
Also, "tampoon" it turns out, is the vaginal packing post-delivery! That's what we figured, but it has been confirmed.
This weekend we traveled to Chennai- we had intended a weekend where we were seeing the general tourist attractions of Chennai including the movie studios and the beach, the temples. Hoping to get some shopping in. Bharvi's uncle had a friend in Chennai who become very excited about showing us around. His famous words over the phone were, "we'll have a banging time!"
with reference mostly to the "DizNee World, MGM Studio" theme park.
We stayed in a hotel named Nayagara Falls with a picture of Niagra. Pretty run down but well meaning staff near this friend's, "Mr. Robynson", work. He was a very kind person who wanted to show us all that was new and modern about Chennai- mostly, all that was Americanized. He was young and Pentacostal- Christians are very obvious in south India, with prayer cards and car decals. While only 20% of the population, they are an outspoken and active part of society.
He lives at home with his parents and brother- has just gotten a new job that requires working with customers on the weekends and owns a scooter and helmet (helmet is actually pretty awesome since they are super expensive and though there is a new law requiring them, only about 2/150 scooterists will have them). He was proud that he is saving up for a car. I am constantly amazed by families of 5 or 6 crammed onto little scooters, baby in dad's arms with two small children perched over his shoulder and a woman riding side-saddle behind. And all the money spent in the US on bicycle helmets! Granted, if they had to wear helmets, they couldn't fit 5 on a scooter!
It is important to note that Chennai has a population of over 6 million, and is a conglomeration of sprawling suburbs with street commerce as far as visible. Like a hundred small Indian towns on top of each other. No street signs. It would be too easy to get lost unless you were looking for a giant IT firm in the center IT district. Those shiny giant buildings with someone watering actual plants in the absence of overwhelming litter are a aberration.
The large street surrounding the IT section actually has lane markings! Not that they mean much. Robyn was excited to point them out, however.
The movie theaters here (we thought about a movie) are about 70% Tamil films (ie: not Bollywood! those films are in Hindi) Robyn wanted to see 300- the English movie here, but we declined. As we did to his wanting to go to "DizzNee World," a theme park on the way to Mamallapuram. It looked fun but we're here for the temples!
Plus we're tired and hot. Poor Robyn- we are just not nearly as fun as he thought.
So, Saturday we get in a small car- we asked for AC, but it was not working well- four of us in the back seat- I was sitting with my knees imbetween the driver and Robyn, hunched foward against the driver's shoulder. Its for a short ride to Chennai beach, right?
wrong!
a few hours later we arrive in Mamallapuram, granted, a better beach and important temples, but we would have liked prior warning. 8th century temples and famous for the stone carvers, using chisels both electric and manual.
This pretty much ate all the time and we liked seeing ancient temples but when we got back only had time for "hamburgers." Robyn who really wanted to show us their new one and only fast food joint "Marry Brown." Of course, we didn't break it to him that burgers in the US are made of beef, not vegetable- he didn't seem to know this. And side dishes usually are not rice and chutney. It was cute though and children ran around the plastic playground just like at home.
(the funniest thing is that there is a counter for ordering but no place to order! everything in India involves sitting with a menu. the counter was just for show- its like they copied the look of an american restaurant without researching what happens at each feature of the architecture!)
The next day we took advantage of what a large place like Chennai has to offer: shops and a mall. The mall was air conditioned with fashionable Indians- no Western clothing on people, only in windows. But we had a great time and found many items completely unavailable in Vellore like pashmina and Diet Pepsi! Ok, so I'm not promising anything, but we did get a bunch of excellent gifts.
And I got Eric a traditional Indian outfit. WIthout the fez. Men's traditional wear is primarily for weddings, so it is expensive. If I were really traditional he would get a dhoti or lunghi as most men wear here day to day, but I think he'd be self-conscious in public. Maybe just a little.
(at first I was going to buy him beautiful white embroidered tunic but then was told that this is what priests wear for weddings- oops)
After much argument with our driver on the way back, we made it to Vellore in time for our CHAD rotation.
A few notes on Southern India:
1. EtOH is available only at euphemistic "Wine Shops"- you see small crowds of men around these shops drinking beer, maybe hard liquor. It is very heavily taxed and frowned upon. I have been known to order a Kingfisher beer to our hotel room despite the "loose American" rumors it probably instigates.
2. There seems to be a silent alarm at 9:45PM to which all women, cows and goats respond by going home. I can be out walking surrounded by all manner of townfolk one minute and then the lone woman for miles the next. Goats bleet at doorsteps and cows lie on thresholds.
3. Our hotel staff know where we are and what we are doing at all times. We provide much amusement. "The Americans!" they shout when we get home so they bring us laundry. We turn in our keys at the front desk everytime we leave and hear what our comrades are doing. The man in the "tops" shop - shirts and fabrics- can tell any of us exactly when another of the other three girls walked in, what she bought, and how much she paid.
When we collect keys, we are told "the other girls are sleeping." or "they ate off the snack menu at 11 AM" (totally unfathomable to eat off the snack menu any time other than 4 pm)
a few times I have returned for my stethoscope or name tag and the man at the front has my key out and waiting. "I told you you'd forget something." sound familiar?
4. Bobbleheading is starting to catch on. Its a S. Indian movement that says "I know what you are saying. I hear you." but looks like they are communicating, "no!" I find myself doing it with rickshaws and restaurant waiters.
Also, "tampoon" it turns out, is the vaginal packing post-delivery! That's what we figured, but it has been confirmed.
This weekend we traveled to Chennai- we had intended a weekend where we were seeing the general tourist attractions of Chennai including the movie studios and the beach, the temples. Hoping to get some shopping in. Bharvi's uncle had a friend in Chennai who become very excited about showing us around. His famous words over the phone were, "we'll have a banging time!"
with reference mostly to the "DizNee World, MGM Studio" theme park.
We stayed in a hotel named Nayagara Falls with a picture of Niagra. Pretty run down but well meaning staff near this friend's, "Mr. Robynson", work. He was a very kind person who wanted to show us all that was new and modern about Chennai- mostly, all that was Americanized. He was young and Pentacostal- Christians are very obvious in south India, with prayer cards and car decals. While only 20% of the population, they are an outspoken and active part of society.
He lives at home with his parents and brother- has just gotten a new job that requires working with customers on the weekends and owns a scooter and helmet (helmet is actually pretty awesome since they are super expensive and though there is a new law requiring them, only about 2/150 scooterists will have them). He was proud that he is saving up for a car. I am constantly amazed by families of 5 or 6 crammed onto little scooters, baby in dad's arms with two small children perched over his shoulder and a woman riding side-saddle behind. And all the money spent in the US on bicycle helmets! Granted, if they had to wear helmets, they couldn't fit 5 on a scooter!
It is important to note that Chennai has a population of over 6 million, and is a conglomeration of sprawling suburbs with street commerce as far as visible. Like a hundred small Indian towns on top of each other. No street signs. It would be too easy to get lost unless you were looking for a giant IT firm in the center IT district. Those shiny giant buildings with someone watering actual plants in the absence of overwhelming litter are a aberration.
The large street surrounding the IT section actually has lane markings! Not that they mean much. Robyn was excited to point them out, however.
The movie theaters here (we thought about a movie) are about 70% Tamil films (ie: not Bollywood! those films are in Hindi) Robyn wanted to see 300- the English movie here, but we declined. As we did to his wanting to go to "DizzNee World," a theme park on the way to Mamallapuram. It looked fun but we're here for the temples!
Plus we're tired and hot. Poor Robyn- we are just not nearly as fun as he thought.
So, Saturday we get in a small car- we asked for AC, but it was not working well- four of us in the back seat- I was sitting with my knees imbetween the driver and Robyn, hunched foward against the driver's shoulder. Its for a short ride to Chennai beach, right?
wrong!
a few hours later we arrive in Mamallapuram, granted, a better beach and important temples, but we would have liked prior warning. 8th century temples and famous for the stone carvers, using chisels both electric and manual.
This pretty much ate all the time and we liked seeing ancient temples but when we got back only had time for "hamburgers." Robyn who really wanted to show us their new one and only fast food joint "Marry Brown." Of course, we didn't break it to him that burgers in the US are made of beef, not vegetable- he didn't seem to know this. And side dishes usually are not rice and chutney. It was cute though and children ran around the plastic playground just like at home.
(the funniest thing is that there is a counter for ordering but no place to order! everything in India involves sitting with a menu. the counter was just for show- its like they copied the look of an american restaurant without researching what happens at each feature of the architecture!)
The next day we took advantage of what a large place like Chennai has to offer: shops and a mall. The mall was air conditioned with fashionable Indians- no Western clothing on people, only in windows. But we had a great time and found many items completely unavailable in Vellore like pashmina and Diet Pepsi! Ok, so I'm not promising anything, but we did get a bunch of excellent gifts.
And I got Eric a traditional Indian outfit. WIthout the fez. Men's traditional wear is primarily for weddings, so it is expensive. If I were really traditional he would get a dhoti or lunghi as most men wear here day to day, but I think he'd be self-conscious in public. Maybe just a little.
(at first I was going to buy him beautiful white embroidered tunic but then was told that this is what priests wear for weddings- oops)
After much argument with our driver on the way back, we made it to Vellore in time for our CHAD rotation.
A few notes on Southern India:
1. EtOH is available only at euphemistic "Wine Shops"- you see small crowds of men around these shops drinking beer, maybe hard liquor. It is very heavily taxed and frowned upon. I have been known to order a Kingfisher beer to our hotel room despite the "loose American" rumors it probably instigates.
2. There seems to be a silent alarm at 9:45PM to which all women, cows and goats respond by going home. I can be out walking surrounded by all manner of townfolk one minute and then the lone woman for miles the next. Goats bleet at doorsteps and cows lie on thresholds.
3. Our hotel staff know where we are and what we are doing at all times. We provide much amusement. "The Americans!" they shout when we get home so they bring us laundry. We turn in our keys at the front desk everytime we leave and hear what our comrades are doing. The man in the "tops" shop - shirts and fabrics- can tell any of us exactly when another of the other three girls walked in, what she bought, and how much she paid.
When we collect keys, we are told "the other girls are sleeping." or "they ate off the snack menu at 11 AM" (totally unfathomable to eat off the snack menu any time other than 4 pm)
a few times I have returned for my stethoscope or name tag and the man at the front has my key out and waiting. "I told you you'd forget something." sound familiar?
4. Bobbleheading is starting to catch on. Its a S. Indian movement that says "I know what you are saying. I hear you." but looks like they are communicating, "no!" I find myself doing it with rickshaws and restaurant waiters.
Thursday, April 19, 2007
"Thanks for Removing the Tampoon"
All this blogging and one comment? This will not do!
Today we rounded and then traveled with an attending- Dr. George to RUHSA- a rural health clinic 40 km outside of Vellore. Here we saw many interesting patients.
But first, on rounds we saw a sad case of osteopetrosis- the child actually seemed pretty happy, talking and talking (maybe 15 months old) and was without cranial nerve involvement yet. But the mother spent time playing with her and alternately crying softly. She was simply here for transfusion- predicted life expectancy of 2 yrs.
All babies here have NG tubes- no OGs in anyone! They were surprised we ever used OG. Another baby had curiously had O2 stopped overnight but O2 sats are not monitored- only checked once a day! She looked good but lordy that would scare me, especially with these apneic little ones.
RUHSA was another experience entirely. First we worked in the clinic- a pediatrician "child specialist" comes once a week and then the local guy who runs the ward rounds with him.
Notes:
1. Everyone who can, gets iron and albendazole. Iron and albendazole. over and over. Many have intestinal worms and so many are anemic (only noticeable when checking gingiva and nail beds). Half the moms get iron also.
2. A good 8 yr old malingerer with abdominal pain. Dr. George threatened him with a NG tube- but he persists in missing school and coming to clinic, costing his family lots of money. Everyone who has seen him classifies him as such- he runs into clinic and pulls up his shirt to be examined, then cries when you touch him! Who knows, but I think they have this one in the bag.
3. Absence seizures- they treat with valproic acid- cant get ethosuximde, but everyone here says they get just as good results with the valproic.
4. We saw an 8 yr old with HIV- unilateral cervical lymph node swelling. And probable PCP. She was completely out of it. Has been taking retrovirals off and on- very tough with few pediatric options and resistance.
5. A child with breathholding spells. About 2 yrs old. SO pretty young for purposeful behavior. The options were seizure, behavioral, and weirdly, iron deficient anemia?! I asked why they were considering this- helps with Valsalva and return blood flow or something?- and Dr. George says he has no idea, but they've seen it before.
6. Young girl with sweaty and itchy palms. They sent her for thyroid tests at the CMC. She was very scared- crying and anxious enough thyrotoxicosis could be possible.
Wards:
The baby of a diabetic mom was delivered and they required the resident to try to get IV access. So we accomapnied to the labor ward. This was the first time I was kind of shocked at the conditions. The baby was a good apgar 9, cheesy, and hanging out on a table. Literally, a fold out table without borders or sides on which they put a cloth and there was a lightbulb above for warming. He had on a few cloths. Granted, its already ridiculously warm in there. But a light bulb for a warmer and I know newborns don't roll too much yet but...
The moms were worse. There were 5 beds- basically a metal table completely flat- maybe 4 feet off the ground, with a depression at the end. Some had stirrup like metal juts- others just required sliding down. The mom who'd had this baby was completely asleep, full sari on, lying on that table.
Two others were in labor- both in their sari's, one with it hitched up and feet flat on the table. But she was contracting and moaning occasionally. What is unbelievable is that we rounded and came back 15 min. later and there was another baby there on that dusty dirty table!
And a bucket under that woman who wasn't even pushing 15 min before had that beautiful third stage of birth in it!
Seriously crazy. Always gross.
We were kind of eyeing that baby cause it looked so pale. But its eyes moved about and seemed to be ok. The two nurse/midwives were wandering about and unconcerned so we took it that the baby was fine.
The title of this blog is a sign that was hanging in the labor ward. Tampoons. We asked Dr. George whether a Tampoon was a tampon and he said he was not an OB and had no idea what a tampon was and would not like to know. He's a very good spirited person.
And religious- we listened to Indian Christian gospel songs all the way in his Suzuki. And weird arrangements of Broadway hits by Indian musicians on the way back.
The pediatric ward is also scary. It was an open room- maybe 20 by 10 feet with 7 children in it. Some wandered to other's beds. The babies were in makeshift warmers with light bulbs for warmth. Of course, the whole place is open and few lights- shade is cooler, so there is a breeze. Also wasps landing on us while we rounded. Lots of children wanting pictures taken. Loud systolic murmur on small baby with ASD and VSD, failure to thrive, there to finish an abx course.
Other stuff:
Many Muslim women in black kaftans with head coverings. Some with face coverings. All must be hellishly hot.
Grandmothers tend to sit in front doorways behind screens in rural and urban areas here. Its funny- you see this face low to the ground, watching the traffic outside, in every single house. I imagine Georgie everytime.
We had Dr. George ask the parents why every child has a thread around his belly with an amulet. They told him that the elders say they must have it, so they do. They have no idea why! Bharvi did note that some places they note a family or town's deity and are for protection. Some of these kids had the amulet and a rosary. One 5 yr old boy had a very grown up leather watch. He cried and cried during auscultation and then kept checking his watch saying it was time to go. That was pretty funny. Especially in the land of no time.
Today we rounded and then traveled with an attending- Dr. George to RUHSA- a rural health clinic 40 km outside of Vellore. Here we saw many interesting patients.
But first, on rounds we saw a sad case of osteopetrosis- the child actually seemed pretty happy, talking and talking (maybe 15 months old) and was without cranial nerve involvement yet. But the mother spent time playing with her and alternately crying softly. She was simply here for transfusion- predicted life expectancy of 2 yrs.
All babies here have NG tubes- no OGs in anyone! They were surprised we ever used OG. Another baby had curiously had O2 stopped overnight but O2 sats are not monitored- only checked once a day! She looked good but lordy that would scare me, especially with these apneic little ones.
RUHSA was another experience entirely. First we worked in the clinic- a pediatrician "child specialist" comes once a week and then the local guy who runs the ward rounds with him.
Notes:
1. Everyone who can, gets iron and albendazole. Iron and albendazole. over and over. Many have intestinal worms and so many are anemic (only noticeable when checking gingiva and nail beds). Half the moms get iron also.
2. A good 8 yr old malingerer with abdominal pain. Dr. George threatened him with a NG tube- but he persists in missing school and coming to clinic, costing his family lots of money. Everyone who has seen him classifies him as such- he runs into clinic and pulls up his shirt to be examined, then cries when you touch him! Who knows, but I think they have this one in the bag.
3. Absence seizures- they treat with valproic acid- cant get ethosuximde, but everyone here says they get just as good results with the valproic.
4. We saw an 8 yr old with HIV- unilateral cervical lymph node swelling. And probable PCP. She was completely out of it. Has been taking retrovirals off and on- very tough with few pediatric options and resistance.
5. A child with breathholding spells. About 2 yrs old. SO pretty young for purposeful behavior. The options were seizure, behavioral, and weirdly, iron deficient anemia?! I asked why they were considering this- helps with Valsalva and return blood flow or something?- and Dr. George says he has no idea, but they've seen it before.
6. Young girl with sweaty and itchy palms. They sent her for thyroid tests at the CMC. She was very scared- crying and anxious enough thyrotoxicosis could be possible.
Wards:
The baby of a diabetic mom was delivered and they required the resident to try to get IV access. So we accomapnied to the labor ward. This was the first time I was kind of shocked at the conditions. The baby was a good apgar 9, cheesy, and hanging out on a table. Literally, a fold out table without borders or sides on which they put a cloth and there was a lightbulb above for warming. He had on a few cloths. Granted, its already ridiculously warm in there. But a light bulb for a warmer and I know newborns don't roll too much yet but...
The moms were worse. There were 5 beds- basically a metal table completely flat- maybe 4 feet off the ground, with a depression at the end. Some had stirrup like metal juts- others just required sliding down. The mom who'd had this baby was completely asleep, full sari on, lying on that table.
Two others were in labor- both in their sari's, one with it hitched up and feet flat on the table. But she was contracting and moaning occasionally. What is unbelievable is that we rounded and came back 15 min. later and there was another baby there on that dusty dirty table!
And a bucket under that woman who wasn't even pushing 15 min before had that beautiful third stage of birth in it!
Seriously crazy. Always gross.
We were kind of eyeing that baby cause it looked so pale. But its eyes moved about and seemed to be ok. The two nurse/midwives were wandering about and unconcerned so we took it that the baby was fine.
The title of this blog is a sign that was hanging in the labor ward. Tampoons. We asked Dr. George whether a Tampoon was a tampon and he said he was not an OB and had no idea what a tampon was and would not like to know. He's a very good spirited person.
And religious- we listened to Indian Christian gospel songs all the way in his Suzuki. And weird arrangements of Broadway hits by Indian musicians on the way back.
The pediatric ward is also scary. It was an open room- maybe 20 by 10 feet with 7 children in it. Some wandered to other's beds. The babies were in makeshift warmers with light bulbs for warmth. Of course, the whole place is open and few lights- shade is cooler, so there is a breeze. Also wasps landing on us while we rounded. Lots of children wanting pictures taken. Loud systolic murmur on small baby with ASD and VSD, failure to thrive, there to finish an abx course.
Other stuff:
Many Muslim women in black kaftans with head coverings. Some with face coverings. All must be hellishly hot.
Grandmothers tend to sit in front doorways behind screens in rural and urban areas here. Its funny- you see this face low to the ground, watching the traffic outside, in every single house. I imagine Georgie everytime.
We had Dr. George ask the parents why every child has a thread around his belly with an amulet. They told him that the elders say they must have it, so they do. They have no idea why! Bharvi did note that some places they note a family or town's deity and are for protection. Some of these kids had the amulet and a rosary. One 5 yr old boy had a very grown up leather watch. He cried and cried during auscultation and then kept checking his watch saying it was time to go. That was pretty funny. Especially in the land of no time.
Wednesday, April 18, 2007
OPC
OK, so this will be short because I wrote this long blog and then my computer turned off and I lost it. NOT because we are in a developing country where the electricity frequently turns off. NOT because the equipment is shoddy, which it isn't. But because I am a total spaz and kicked the cord.
So outpatient ward is crazy: two residents today, one room, 144 patients, ppl walking through. One exam table (a flat board on stilts) One stool- for patient. Parents stand. All day, no break.
Interesting patients of the million:
1. 15 y/o M with swollen knees, ankles- serious arthralgia causing crying and anguish coming in. Broke his foot when couldnt walk due to pain and fell. Admitted for acute rheumatic fever vs rheumatoid process. Gonococal arthritis, while unlikely, was totally not on the radar for differential. They looked at me like I was a space alien.
2. 9 y/o M with syncope and LVH on EKG. Will get echo. Until parents can raise money, sit when getting faint.
3. Small corn on foot. 40- Rs for corn removal. That's like 90 cents. Why they came so far when child barefoot anyway all day walking on cow poo? You got me. Probably, as the attending pointed out, because another family member was having major surgery or something and everyone gets checked out while they're here.
4. 11 y/o M with pectus cavus- recurrent lung disease but prob not due to cavus. Parents, btw, look exactly the same. Which prompted me to ask about consanguinity in India which they noted was pretty common.
5. Wilson's kid for checkup- got the see the Kaiser- Fleischer rings! Green/Gold above iris.
Improved and walking with support.
6. 11 y/o M with what seemed clear Tourettes syndrome. Neck tic. Parents did not like this though and had a long convoluted story of a bite on the foot and relapsing fevers. The attending had me secretely watch the child has he hung around outside the room and I reported the tic continued, albeit at a lesser pace. Strangely, the residents were really nervous about ruling out WIlson's and got all hung up about getting a ceruloplasmin and an optho consult. I thought that was a strange move. They noted they had never prescribed psych drugs and didn't know about this pimozide they thought he might use.
7. Sudden onset blindness in 5 month old. Put on anticoagulants and monitored. Strange regain of vision 4 months later (most of it as far as we can tell.) Parents said they prayed for a long long time.
Observations:
1. Asked about child abuse- attending said she had heard of one case and wondered what indicators we had that it was going on. They don't see much OR they don't diagnose much OR there isn't much. I will go with a combo of the formers.
2. Doctors are fairly harsh and businesslike with patients and parents. Children who cry are sent out if they are too loud. Occasionally, a child will get to play with a tongue depressor to quiet them. Otherwise, out. I drew pictures on one and then they sent out all the upset ones so I didnt' get to give it away. A few male pediatricians smile at the babies and play with them, but that's it. Parents must be extremely respectful and never question or bother when the MD is consulting with another doctor or discussing another case.
3. No toys with patients= no foods. They may have water in a bottle, but nothing else. There was a guy dressed up in raggedy monkey outfit teasing kids outside the rooms. This was new. The head of nephrology yesterday expressed her frustration at not having anything like Child Life or toys or things to help distract children when they have procedures. There is one tricycle in the ward which is used by a fast, daring sibling who must want to be a rickshaw driver.
4. Rickshaws are awesome. I wish we had them in the US (except we'd probably find a way to make them more lethal). Its like a cheap wild ride through town- so fun. I feel like Mr. Toad everytime.
5. Exams are pretty rough- no niceties, but that is fine. Mostly, they are just not necessary for most patients in this system and I have never seen parts of the exam done. No lymph nodes, thyroid, any genital anything, strength, abd auscultation.
6. Flowers in the hair- did I mention? Everyone has these lovely white adn orange flowers briaded together they buy on the street and they smell amazing.
7. A bunch of people live here who appear South Asian- not sure if they have come for medical training or were a part of an earlier migration. But it is interesting.
8. BTW, short sleeves totally ok. I should never have listened to those other bloggers! Crazy pants, they are!
9. Occasionally, I see male cross dressers- they are a special group here- appear and make noise at weddings I've read in the book. But a startling sight when seen--in the midst of all these saris on tiny women, a 6 foot sari!
So outpatient ward is crazy: two residents today, one room, 144 patients, ppl walking through. One exam table (a flat board on stilts) One stool- for patient. Parents stand. All day, no break.
Interesting patients of the million:
1. 15 y/o M with swollen knees, ankles- serious arthralgia causing crying and anguish coming in. Broke his foot when couldnt walk due to pain and fell. Admitted for acute rheumatic fever vs rheumatoid process. Gonococal arthritis, while unlikely, was totally not on the radar for differential. They looked at me like I was a space alien.
2. 9 y/o M with syncope and LVH on EKG. Will get echo. Until parents can raise money, sit when getting faint.
3. Small corn on foot. 40- Rs for corn removal. That's like 90 cents. Why they came so far when child barefoot anyway all day walking on cow poo? You got me. Probably, as the attending pointed out, because another family member was having major surgery or something and everyone gets checked out while they're here.
4. 11 y/o M with pectus cavus- recurrent lung disease but prob not due to cavus. Parents, btw, look exactly the same. Which prompted me to ask about consanguinity in India which they noted was pretty common.
5. Wilson's kid for checkup- got the see the Kaiser- Fleischer rings! Green/Gold above iris.
Improved and walking with support.
6. 11 y/o M with what seemed clear Tourettes syndrome. Neck tic. Parents did not like this though and had a long convoluted story of a bite on the foot and relapsing fevers. The attending had me secretely watch the child has he hung around outside the room and I reported the tic continued, albeit at a lesser pace. Strangely, the residents were really nervous about ruling out WIlson's and got all hung up about getting a ceruloplasmin and an optho consult. I thought that was a strange move. They noted they had never prescribed psych drugs and didn't know about this pimozide they thought he might use.
7. Sudden onset blindness in 5 month old. Put on anticoagulants and monitored. Strange regain of vision 4 months later (most of it as far as we can tell.) Parents said they prayed for a long long time.
Observations:
1. Asked about child abuse- attending said she had heard of one case and wondered what indicators we had that it was going on. They don't see much OR they don't diagnose much OR there isn't much. I will go with a combo of the formers.
2. Doctors are fairly harsh and businesslike with patients and parents. Children who cry are sent out if they are too loud. Occasionally, a child will get to play with a tongue depressor to quiet them. Otherwise, out. I drew pictures on one and then they sent out all the upset ones so I didnt' get to give it away. A few male pediatricians smile at the babies and play with them, but that's it. Parents must be extremely respectful and never question or bother when the MD is consulting with another doctor or discussing another case.
3. No toys with patients= no foods. They may have water in a bottle, but nothing else. There was a guy dressed up in raggedy monkey outfit teasing kids outside the rooms. This was new. The head of nephrology yesterday expressed her frustration at not having anything like Child Life or toys or things to help distract children when they have procedures. There is one tricycle in the ward which is used by a fast, daring sibling who must want to be a rickshaw driver.
4. Rickshaws are awesome. I wish we had them in the US (except we'd probably find a way to make them more lethal). Its like a cheap wild ride through town- so fun. I feel like Mr. Toad everytime.
5. Exams are pretty rough- no niceties, but that is fine. Mostly, they are just not necessary for most patients in this system and I have never seen parts of the exam done. No lymph nodes, thyroid, any genital anything, strength, abd auscultation.
6. Flowers in the hair- did I mention? Everyone has these lovely white adn orange flowers briaded together they buy on the street and they smell amazing.
7. A bunch of people live here who appear South Asian- not sure if they have come for medical training or were a part of an earlier migration. But it is interesting.
8. BTW, short sleeves totally ok. I should never have listened to those other bloggers! Crazy pants, they are!
9. Occasionally, I see male cross dressers- they are a special group here- appear and make noise at weddings I've read in the book. But a startling sight when seen--in the midst of all these saris on tiny women, a 6 foot sari!
Tuesday, April 17, 2007
more on the wards...
This will be a short post- its another day on the wards...
We saw several patients on rounds but left early to hear med student presentations on Hemolytic Anemia and Thallassemias. Then we returned for a "Journal Club" on urine testing and went to micro pathology to see examples of nephrotic syndromes on slides from the past month.
On the wards we saw a baby- born at 32 wks, hospitalized for a month, home for three days, returned with aspiration; intubated twice.... etc...etc.. The one thing of note was that with this baby they had pushed epi peripherally and there was terrible gangrene necrosis at the site. Yikes. It was awful looking and just lying there on the large child's bed. They noted that these parents had not paid for any care yet, and their grace period was over. They will probably have to let this baby die very soon. There is a set period during which the hospital will cover costs for unstable cases after which point most patients receive limited care.
A second child surprised the physicians by yelling at them after they called him "Judi"- his mother's printed name on the sign "Judi's baby." He yelled "Kevin!!" and pointed to himself. It was explained that lately alot of parents have been surfing the internet for western names and they have seen in clinic all the kings of England and several Lincolns. Kevin seems an unlikely aberration.
They use cisapride regularly on infants (although not on adults). Alot of American neonatologists wish they could since its off the market due to adult arrhythmias.
The SSPE case is still baffling everyone. The diagnosis was made at an oustide facility which had a CT no contrast (looks normal). What do you think? 9 yr old male, handwriting deteriorates, peripheral atrophy and tremor- mostly fingers, arms- like intention tremor but severe. Occasional spastic abdominal muscles, legs weak, atrophic. Inability to walk without someone to fall on, feed self, use restroom. Cognitively intact. Tongue fasciculations, strange cogwheel-like rigidity. Normal reflexes. Ok, so that wasn't in any presentable order, and its what I observed of his exam, but any thoughts? I guess I could read up online....
that's crazy talk.
I do not want to offend anyone- this is an honest observation- but I have found much of the academic discussions curious in comparison to our US discussions. For example, "Journal Club" featured not an article about new research or a comparison study of urinary testing tactics, but rather an article just generally explaining what urinary testing was, the diseases associated with leukocyte esterase etc...
The resident presented a very general article- I don't know how to say this- but it was MSIII level. The powerpoint explained everything you could test in urine and what diseases are associated with casts etc etc.
In all the presentations we've seen and discussions we've witnessed, none have had "evidence-based medicine-" no mention of articles demonstrating effective or ineffective treatment or testing.
Everything is referenced from Nelson's- it was not Journal Club as we know it.
The medical student's presentations were required to be on the chalkboard- no powepoint- because they might "paste and copy." They were pretty simple= they are only second years! which makes them college sophomores!
The way in which the attendings motivate the residents to think about disease is also different. I find myself frustrated not to hear the thought process moving in the fashion I have come to find predictable. But it is a subtlety of the training. It is admirable how much time is spent asking the radiologist and pathologists questions.
Oh, we also saw a renal biopsy. Very little of the room was sterilized- about as much as for an I&D. The child was given versed but still cried and cried from fright. They used a biopsy gun- small and had ultrasound guidance prior to starting. I took pictures. No gowns, sandals fo sho.
That's all for now! We are trying to decide if we have the time to go to Ooty this weekend or should hang out here. Love to everyone at home. We are all very much missing Mexican food.
We saw several patients on rounds but left early to hear med student presentations on Hemolytic Anemia and Thallassemias. Then we returned for a "Journal Club" on urine testing and went to micro pathology to see examples of nephrotic syndromes on slides from the past month.
On the wards we saw a baby- born at 32 wks, hospitalized for a month, home for three days, returned with aspiration; intubated twice.... etc...etc.. The one thing of note was that with this baby they had pushed epi peripherally and there was terrible gangrene necrosis at the site. Yikes. It was awful looking and just lying there on the large child's bed. They noted that these parents had not paid for any care yet, and their grace period was over. They will probably have to let this baby die very soon. There is a set period during which the hospital will cover costs for unstable cases after which point most patients receive limited care.
A second child surprised the physicians by yelling at them after they called him "Judi"- his mother's printed name on the sign "Judi's baby." He yelled "Kevin!!" and pointed to himself. It was explained that lately alot of parents have been surfing the internet for western names and they have seen in clinic all the kings of England and several Lincolns. Kevin seems an unlikely aberration.
They use cisapride regularly on infants (although not on adults). Alot of American neonatologists wish they could since its off the market due to adult arrhythmias.
The SSPE case is still baffling everyone. The diagnosis was made at an oustide facility which had a CT no contrast (looks normal). What do you think? 9 yr old male, handwriting deteriorates, peripheral atrophy and tremor- mostly fingers, arms- like intention tremor but severe. Occasional spastic abdominal muscles, legs weak, atrophic. Inability to walk without someone to fall on, feed self, use restroom. Cognitively intact. Tongue fasciculations, strange cogwheel-like rigidity. Normal reflexes. Ok, so that wasn't in any presentable order, and its what I observed of his exam, but any thoughts? I guess I could read up online....
that's crazy talk.
I do not want to offend anyone- this is an honest observation- but I have found much of the academic discussions curious in comparison to our US discussions. For example, "Journal Club" featured not an article about new research or a comparison study of urinary testing tactics, but rather an article just generally explaining what urinary testing was, the diseases associated with leukocyte esterase etc...
The resident presented a very general article- I don't know how to say this- but it was MSIII level. The powerpoint explained everything you could test in urine and what diseases are associated with casts etc etc.
In all the presentations we've seen and discussions we've witnessed, none have had "evidence-based medicine-" no mention of articles demonstrating effective or ineffective treatment or testing.
Everything is referenced from Nelson's- it was not Journal Club as we know it.
The medical student's presentations were required to be on the chalkboard- no powepoint- because they might "paste and copy." They were pretty simple= they are only second years! which makes them college sophomores!
The way in which the attendings motivate the residents to think about disease is also different. I find myself frustrated not to hear the thought process moving in the fashion I have come to find predictable. But it is a subtlety of the training. It is admirable how much time is spent asking the radiologist and pathologists questions.
Oh, we also saw a renal biopsy. Very little of the room was sterilized- about as much as for an I&D. The child was given versed but still cried and cried from fright. They used a biopsy gun- small and had ultrasound guidance prior to starting. I took pictures. No gowns, sandals fo sho.
That's all for now! We are trying to decide if we have the time to go to Ooty this weekend or should hang out here. Love to everyone at home. We are all very much missing Mexican food.
Monday, April 16, 2007
new hospital day
Another day at the hospital...
New random thoughts:
1. Residents are all young- its like our system pretty much except without college. So I realized we are older than all the residents!
2. Females are scarce in the wards. And no female babies. I have not asked about this yet but I think the families who travel bring only sons this distance for the most part. The girls we see are more chronic issues who had not been treated as early as they should. Funnily enough, half the kids appear to be girls with pig tails and pink shirts. Only upon inspection...
3. Many babies up to 3 yrs are unnamed- they are labeled as ex. "Saratha's baby."
4. I forgot my toilet paper today. I had to try the Indian method and it wasn't too horrible. But I will remember from now on.
5. Taking pictures IN the ward is very hard. It seems flippant to take pictures when children are so ill. I have, however, gotten a picture of ricketts- it was not easy and took translation and many many thanks. I write to indicate to the donors why we have so few hospital pictures. It seems crass. Parents are already concerned about evil eye when you look at the children too long-pictures are often inappropriate.
Patients:
1. Neonatal seizures- EEG at 3 weeks once parents can rack up the $
2. 3 y/o intermittent fevers/seizures. This child was so drowsy during the exam and finally woke up to stare at me watching from the corner and cry, "protect me, spirit! protect me from these evil doers!" the residents thought that was pretty funny. He picked the pale ghost face. Sunscreen is working.
3. Lots more neonatal seizures- cosanguinous twins at one. Microcephaly, SGA. (Although there are lots of "term" babies here who are incredibly small looking). HypoCa, Hypogly- on phenobarb. Have these interesting covers for misting O2 over heads. One twin is in a big kid's bed; the other a crib. I think that might be Child Health II's only crib.
4. Ankita: the CXR is of her chest. She is the small girl with scoliosis and terrible dyspnea/tachy at rest. She will have an EKG today- I think this chronic infective process is the result of her pulm HTN combined with right heart failure due to likely anatomic abnormality. CT had mosaic multi-densities. I wish they would focus on cardio and get an echo. They are thinking weird alveolitis and rare interstitial disease although there is not fibrosis on CXR. Just huge vascular markings and slight lower lobe consolidation. Parents can't afford another study anyway. Too tachy to hear fixed split or loud S2.
More interesing:
At one bed they were recommending cow's milk over formula and I'm sure we made a funny face. It was explained that so many families can't keep bottles clean in any way and can only afford a little formula. So the children get watered down formula in unsanitary bottles (which often come with the fmla they buy). INstead, they just say go ahead with the cow's milk and boil with water or by itself- greater fat content than watered down fmla. Then they use a "birds beak" tiny metal cup which can more easily be cleaned and does not hold bacteria like rubber nipples. The beak rests in the baby's mouth and has some suckle function. All the mom's used these in the hospital and when caught bottle feeding, were in trouble!
Several children (one with cerebral palsy and neurogenic bladder) were on imipenem and meropenem. An attending said, "Did you know, we just found out we have e coli resistant to every abx in this hospital!!" I thought that would not be surprising when 100% are on cefotaxime and 20% on imipenem, but it seemed pretty new to him...
Also saw selective IgA deficiency and the ricketts- no renal cause and continued deformity. Perhaps an osteodystrophic syndrome.
Sunday, April 15, 2007
pondicherry or "Chicken 65: Do we need to explain?"
Hola folks
this will be short as this keyboard is terrible and connection not hot. we left for Pondicherry this weekend. Its a French colonial holdout on the Bay of Bengal, liberated slightly before the rest of India.
Highpoint: being treated like VIPs at the Tamil New Year's parade and given prime seats behind some big politico. Plus, the amazing costumes and dances.
Will do this on a list--
Drive over:
1. Our driver spoke ZERO English and was on the low IQ side (plus no deoderant)- we stopped everywhere for directions and Indians were so frustrated with him- almost as much as we were since we had a map he refused to use or listen to our instructions in bad Tamil.
2. COuntryside with 3 monkeys seen, beautiful birds, searing heat. Lots of little towns with thatched roofs and older folks tending goats sleeping on rocks.
3. 1 busted tire during 4 hour drive. Apparently this is a good ratio.
Hotel:
1. Park, the sought after ashram, did not have rooms AND it was new year, so we paid an inflated price. The place we stayed was on the beach (which is rock with a sand walkway above)
though and prime spot for new years festivities.
2. Bad night management- a story I will tell later. We owe a great deal to Bharvi and her fierce rhetoric, consternation, and absence of fear in the face of bad management who woke us up 3 times. We will find our friends at the tourist bureau and complain loudly.
3. Lunch at hotel was funny. Title of blog a menu item. Other menu items included "magic" ingredients and egg rolls that "activate million senses"
Ashram:
1. had to take off our shoes across the street and be silent in the presence of the ashram. An old lady directed us (who knew you could be bossy with only hand movements and facial expressions!) to the shrine like area. To tell the truth, is definitely more meaningful for believers.
2. many meditators on stone floors. yikes
3. guru was Sri Aurobindo and "The Mother" Many books for sale with their wise sayings
Shopping:
1. possibly smellier in Pondy. Nothing to buy.
French Area:
1. ate fabulous breakfast at French-like place with BLACK coffee (althuogh eau de tree bark)
crepes and soft boiled eggs with GOOD toast. Lovely. OUtside and hot with stray dogs sleeping on our bags, but lovely.
2. Not so good dinner. Crevettes with tomato sauce. And french fries. And wine (VERY expensive here! still like 150 rs. which equals $3, but that's more than I'll pay for food in a whole day!)
3. many (by which I mean I think we saw 15-20 the whole time) european tourists and a few creepy old french men- there since the 50s.
New Year:
Fabulous! Cannot describe without pictures and video- but you will see when I get back.
I think we were on TV cause they kept filming us in these places of honor where some tourist bureau dude put us after asking "tourist?" "sit! now! here!"
They had fireworks but we missed them waiting for my stupid french fries. Serves me right for not getting "Italian soft ice cream" ie: fro yo, instead.
Other:
1. we saw two elephants, painted- one walking down the street and one in the city.
2. all the awesome cows have painted horns and bells on. They are totally nonchalant about their newfound beauty.
3. I am still really excited about the monkeys. They were sitting in the bus stop in the middle of nowhere. and eating stuff. Another one was watching the road on a post.
4. have not gotten sick yet- but have needed Prilosec. Am eating only hotel food (pretty much where all the restaurants are anyways...) except in Pondy.
OK, so I said it would be short but I lied. Sorry you got suckered into reading!
this will be short as this keyboard is terrible and connection not hot. we left for Pondicherry this weekend. Its a French colonial holdout on the Bay of Bengal, liberated slightly before the rest of India.
Highpoint: being treated like VIPs at the Tamil New Year's parade and given prime seats behind some big politico. Plus, the amazing costumes and dances.
Will do this on a list--
Drive over:
1. Our driver spoke ZERO English and was on the low IQ side (plus no deoderant)- we stopped everywhere for directions and Indians were so frustrated with him- almost as much as we were since we had a map he refused to use or listen to our instructions in bad Tamil.
2. COuntryside with 3 monkeys seen, beautiful birds, searing heat. Lots of little towns with thatched roofs and older folks tending goats sleeping on rocks.
3. 1 busted tire during 4 hour drive. Apparently this is a good ratio.
Hotel:
1. Park, the sought after ashram, did not have rooms AND it was new year, so we paid an inflated price. The place we stayed was on the beach (which is rock with a sand walkway above)
though and prime spot for new years festivities.
2. Bad night management- a story I will tell later. We owe a great deal to Bharvi and her fierce rhetoric, consternation, and absence of fear in the face of bad management who woke us up 3 times. We will find our friends at the tourist bureau and complain loudly.
3. Lunch at hotel was funny. Title of blog a menu item. Other menu items included "magic" ingredients and egg rolls that "activate million senses"
Ashram:
1. had to take off our shoes across the street and be silent in the presence of the ashram. An old lady directed us (who knew you could be bossy with only hand movements and facial expressions!) to the shrine like area. To tell the truth, is definitely more meaningful for believers.
2. many meditators on stone floors. yikes
3. guru was Sri Aurobindo and "The Mother" Many books for sale with their wise sayings
Shopping:
1. possibly smellier in Pondy. Nothing to buy.
French Area:
1. ate fabulous breakfast at French-like place with BLACK coffee (althuogh eau de tree bark)
crepes and soft boiled eggs with GOOD toast. Lovely. OUtside and hot with stray dogs sleeping on our bags, but lovely.
2. Not so good dinner. Crevettes with tomato sauce. And french fries. And wine (VERY expensive here! still like 150 rs. which equals $3, but that's more than I'll pay for food in a whole day!)
3. many (by which I mean I think we saw 15-20 the whole time) european tourists and a few creepy old french men- there since the 50s.
New Year:
Fabulous! Cannot describe without pictures and video- but you will see when I get back.
I think we were on TV cause they kept filming us in these places of honor where some tourist bureau dude put us after asking "tourist?" "sit! now! here!"
They had fireworks but we missed them waiting for my stupid french fries. Serves me right for not getting "Italian soft ice cream" ie: fro yo, instead.
Other:
1. we saw two elephants, painted- one walking down the street and one in the city.
2. all the awesome cows have painted horns and bells on. They are totally nonchalant about their newfound beauty.
3. I am still really excited about the monkeys. They were sitting in the bus stop in the middle of nowhere. and eating stuff. Another one was watching the road on a post.
4. have not gotten sick yet- but have needed Prilosec. Am eating only hotel food (pretty much where all the restaurants are anyways...) except in Pondy.
OK, so I said it would be short but I lied. Sorry you got suckered into reading!
Friday, April 13, 2007
other stuff...
Things I forgot!
We got our eyebrows threaded yesterday- happened upon a "feminine" store and there was a woman who threaded for 10 Rs.
This is like literally 20 cents.
It was so hot she had to powder all over my head to get a grip on my eyebrows!
and it was painful. I will say. Not as bad as tweezing, but she took a lot off and wowee it hurt.
I finally bought 5 cotton tops and a salwar. So I don't stick out as much. Problem is, the salwar needs tweaking and a string for the pants. Too many details in Indian retail!
This afternoon we also attended clinic. This is a jungle. A small room with three residents, three stools and patients filing in and out quickly. Complicated patients. Nephrotic patients on Ca gluconate chronically. And they had 5 min. for each. In a tiny room- again, no HIPPA. This was all in Tamil and we were very much in the way- needless to say, we left a little early as the clinic madness goes until 8 PM!
Also, we were told that a year ago there was a spat of kerosene aspirations because Pepsi was marketing a blue drink matching domestic kerosene color. Our attending, Dr. George, noted that they still watch out for this as some children remember that Pepsi taste too well. It is ironic that a company would happen to market such a strange color drink in a country constantly using old fuels of the same color. As long as Nestle doesn't market a burning cow-patty colored chocolate...
We got our eyebrows threaded yesterday- happened upon a "feminine" store and there was a woman who threaded for 10 Rs.
This is like literally 20 cents.
It was so hot she had to powder all over my head to get a grip on my eyebrows!
and it was painful. I will say. Not as bad as tweezing, but she took a lot off and wowee it hurt.
I finally bought 5 cotton tops and a salwar. So I don't stick out as much. Problem is, the salwar needs tweaking and a string for the pants. Too many details in Indian retail!
This afternoon we also attended clinic. This is a jungle. A small room with three residents, three stools and patients filing in and out quickly. Complicated patients. Nephrotic patients on Ca gluconate chronically. And they had 5 min. for each. In a tiny room- again, no HIPPA. This was all in Tamil and we were very much in the way- needless to say, we left a little early as the clinic madness goes until 8 PM!
Also, we were told that a year ago there was a spat of kerosene aspirations because Pepsi was marketing a blue drink matching domestic kerosene color. Our attending, Dr. George, noted that they still watch out for this as some children remember that Pepsi taste too well. It is ironic that a company would happen to market such a strange color drink in a country constantly using old fuels of the same color. As long as Nestle doesn't market a burning cow-patty colored chocolate...
peds ward patients
To tell about the patients, I will need to take a deep breath and just list diseases...
BTW, no such thing as HIPPA in India. Or any AC in the hospital. Anywhere. Beds are old iron and several in a room with green surgicaltype small cloths on mattresses where hips and head go. Parents (moms- dads are kind of kicked out when visiting hrs are done) stand (no chairs) and sleep curled next to children in the small beds.
1. 1.5 yr old, LRI- in the last 5 yrs has outdone gastroenteritis as the leading cause of death in children under 5 yrs old. Increasing asthma- as a result, increasing theophylline (the mainstay here) poisonings.
2. 11 yr, tachy, dyspnea at rest for last 1.5 yrs, marasmus, scoliosis: possible TB, with marked clubbing, peripheral cyanosis, terrible fibrotic sounding lungs. pO2 57. Pulm HTN. Very sad- no parents have been seen. (which means no one to help get her food or feed her)
3. 10 yr, Wilson's dz (several recent cases weirdly enough) presenting first with neural sxs (very rare- no jaundice, just neuro) Handwriting deteriorated, then ataxic gait. Frontal lobe doing well but totally lacking muscle control neck-down. Kaiser-Fleisher rings. From Calcutta. Is throwing up pennicillamine but other drug is too$$.
4. 8 yr, CRF and sepsis- due to post. urethral valves. Looks 4- bad marasmus (parents also look it). Admitted with hgb of 3. Two transfusions. Tx with cefotaxime.
5. 1.5 yr old- unk. poisoning- possible theophylline or OP. No drooling as expected with OP.
Saw many other cases in addition but I couldn't keep writing cause a new gp joined us and they speak so softly I can't hear anything!! Among them however were rheumatic fever with pericarditis and migrating nodules. And subacute sclerosing panencephalitis- very sad- lots of involuntary mvts and spastic limbs. Several nephrotic syndrome also (but I think our attending was a nephrologist so....)
BTW, no such thing as HIPPA in India. Or any AC in the hospital. Anywhere. Beds are old iron and several in a room with green surgicaltype small cloths on mattresses where hips and head go. Parents (moms- dads are kind of kicked out when visiting hrs are done) stand (no chairs) and sleep curled next to children in the small beds.
1. 1.5 yr old, LRI- in the last 5 yrs has outdone gastroenteritis as the leading cause of death in children under 5 yrs old. Increasing asthma- as a result, increasing theophylline (the mainstay here) poisonings.
2. 11 yr, tachy, dyspnea at rest for last 1.5 yrs, marasmus, scoliosis: possible TB, with marked clubbing, peripheral cyanosis, terrible fibrotic sounding lungs. pO2 57. Pulm HTN. Very sad- no parents have been seen. (which means no one to help get her food or feed her)
3. 10 yr, Wilson's dz (several recent cases weirdly enough) presenting first with neural sxs (very rare- no jaundice, just neuro) Handwriting deteriorated, then ataxic gait. Frontal lobe doing well but totally lacking muscle control neck-down. Kaiser-Fleisher rings. From Calcutta. Is throwing up pennicillamine but other drug is too$$.
4. 8 yr, CRF and sepsis- due to post. urethral valves. Looks 4- bad marasmus (parents also look it). Admitted with hgb of 3. Two transfusions. Tx with cefotaxime.
5. 1.5 yr old- unk. poisoning- possible theophylline or OP. No drooling as expected with OP.
Saw many other cases in addition but I couldn't keep writing cause a new gp joined us and they speak so softly I can't hear anything!! Among them however were rheumatic fever with pericarditis and migrating nodules. And subacute sclerosing panencephalitis- very sad- lots of involuntary mvts and spastic limbs. Several nephrotic syndrome also (but I think our attending was a nephrologist so....)
peds ward cont...
Amazingly, after prayer they served hot!! (while prob 90 degrees inside) coffee and one resident brought Rossogolla which the elaborate packaging states is "A Sweet of Uncomparable Delicacy." They teased each other and fought over the small white balls. This was the rare Indian food I do not understand and had to force down: a white sea-sponge texture that sticks to the tongue sopped in sugar liquid. I tried to be graceful about it. I failed.
After a presentation on chronic liver disease, we get to the patients!
Interesting, about residents and nurses:
1. Language: All medical-speak was in English. Talking about the call schedule in Hindi and Tamil. Talking to pts in Tamil.
2. Women wearing Salwars and Saris and all men in button downs and long pants. Of course, not a tie seen in India yet- just in a shop window.
3. Nurses wear long white saris- very beautiful with old-timey nursing hats. Student nurses wear white coats but no med students or residents wear them.
4. Pt charts in English. Orders in English.
5. All residents who get a traumatic lumbar tap have to take everyone out for ice cream.
After a presentation on chronic liver disease, we get to the patients!
Interesting, about residents and nurses:
1. Language: All medical-speak was in English. Talking about the call schedule in Hindi and Tamil. Talking to pts in Tamil.
2. Women wearing Salwars and Saris and all men in button downs and long pants. Of course, not a tie seen in India yet- just in a shop window.
3. Nurses wear long white saris- very beautiful with old-timey nursing hats. Student nurses wear white coats but no med students or residents wear them.
4. Pt charts in English. Orders in English.
5. All residents who get a traumatic lumbar tap have to take everyone out for ice cream.
Pediatrics ward
Today was our first day on the job. I have many things I could write as I took a full history on each child, pretty much. The day started early and we set out to find the crowded wards. The hospital is on a campus with a few gates, security in place. However, there are mass crowds inside and I'm not sure why they are there. People wait in "lobbies" for hours and hours to sign in to then wait in a clinic. Of course, some have traveled for days.
Interestingly, the first thing we did was go to a weekly chaplain-led Bible study and discussion. The hospital is Christian and ostensibly so are the residents as we met with an 60-something English lady who organized the discussion. The hospital publishes weekly guides for all residents and each department participates separately. At the bottom of the weekly Bible verses and discussion questions are prayers specifically for departments like "Dr. Kumar and staff in Pathology."
While I thought it was pretty wonderful, I could tell the residents were kind of apathetic- sitting there quietly just like they do in the US during Discharge Planning Painful Meetings. As soon as she left, they burst into conversation over new admits.
The residents were female heavy as in Peds in the US nowadays. The attendings commanded a great deal of respect and were cheerful and eager to ask questions- pimping for the residents and curiousity "Is sweat chloride the first-line testing in the US for CF?" for Ileana and me.
Interestingly, the first thing we did was go to a weekly chaplain-led Bible study and discussion. The hospital is Christian and ostensibly so are the residents as we met with an 60-something English lady who organized the discussion. The hospital publishes weekly guides for all residents and each department participates separately. At the bottom of the weekly Bible verses and discussion questions are prayers specifically for departments like "Dr. Kumar and staff in Pathology."
While I thought it was pretty wonderful, I could tell the residents were kind of apathetic- sitting there quietly just like they do in the US during Discharge Planning Painful Meetings. As soon as she left, they burst into conversation over new admits.
The residents were female heavy as in Peds in the US nowadays. The attendings commanded a great deal of respect and were cheerful and eager to ask questions- pimping for the residents and curiousity "Is sweat chloride the first-line testing in the US for CF?" for Ileana and me.
Thursday, April 12, 2007
Wednesday, April 11, 2007
also....
Aha
so I forgot to write about the food. So far we have eaten at our hotel restaurant twice. They are pretty good! So I say poo to those who didn't like their food. The best was the cauliflower and eggplant dishes- better than expected and I though the same type of tasty as PFChangs eggplant and ground chicken. Breakfast was traditional Indian breakfast with several gravys/curries/masalas.
so I forgot to write about the food. So far we have eaten at our hotel restaurant twice. They are pretty good! So I say poo to those who didn't like their food. The best was the cauliflower and eggplant dishes- better than expected and I though the same type of tasty as PFChangs eggplant and ground chicken. Breakfast was traditional Indian breakfast with several gravys/curries/masalas.
Vellore arrival
So, after arranging an AC car- yes, we paid for it- watching buses going by with people crammed in every which-way, made the decision easy. Although our driver was knowledgeable and the ride smooth despite numerous near misses with large oxes and diesel trucks, it took many hours to arrive and it was too late after getting to Aavanaa and negotiating price and rooms with the management to get to the CMC main campus for registration.
On the road: honking is wildly encouraged- every truck with language like "sound yourself!" Lots of very large projects are in the making: Hyundai plants, Motorola compounds. They will bus hundreds of employees out from town every day.
Vellore is a largish town, the least savory street scene being in front of the hospital where we are. Many beggar children grab your pants and follow for blocks. Most folks with disabilities congregate here- it makes sense. The hospital itself is imposing and large with steady streams of people in and out. We will see tomorrow what it holds.
We rickshawed out to CMC which is a good 15 min ride with four of us crammed into the back! After wandering around the engineering school which was beautiful filled with gardens and scented flowers, we registered at the principals office and signed up.
Despite everyone's advice, we are saving CHAD for the last week and starting pediatrics tomorrow. Child's health is at the main hospital and we are completely unsure of what it will entail- rounds? bedside? clinic? hours? OK, we did get that it is on the 5th floor of the "new" building. We also received ID's.
We found this internet cafe by wandering around the "downtown?" area near Hotel Darling.
BTW, we have an unencumbered view of the Rotary Field from our hotel which is really just a huge dirt area where we can watch 24hr Cricket, played by hundreds of boys of all ages.
I can't believe how much they run, in full pants and button-downs in the intense afternoon heat. Without a coach yelling at them!
On the road: honking is wildly encouraged- every truck with language like "sound yourself!" Lots of very large projects are in the making: Hyundai plants, Motorola compounds. They will bus hundreds of employees out from town every day.
Vellore is a largish town, the least savory street scene being in front of the hospital where we are. Many beggar children grab your pants and follow for blocks. Most folks with disabilities congregate here- it makes sense. The hospital itself is imposing and large with steady streams of people in and out. We will see tomorrow what it holds.
We rickshawed out to CMC which is a good 15 min ride with four of us crammed into the back! After wandering around the engineering school which was beautiful filled with gardens and scented flowers, we registered at the principals office and signed up.
Despite everyone's advice, we are saving CHAD for the last week and starting pediatrics tomorrow. Child's health is at the main hospital and we are completely unsure of what it will entail- rounds? bedside? clinic? hours? OK, we did get that it is on the 5th floor of the "new" building. We also received ID's.
We found this internet cafe by wandering around the "downtown?" area near Hotel Darling.
BTW, we have an unencumbered view of the Rotary Field from our hotel which is really just a huge dirt area where we can watch 24hr Cricket, played by hundreds of boys of all ages.
I can't believe how much they run, in full pants and button-downs in the intense afternoon heat. Without a coach yelling at them!
Arrival
Hello! So we have finally arrived. I came late and Ileana, Lauren and Bharvi were very very kind to wait for me. We were picked up and ferried to the Sheraton post-midnight. Our original more practical hotel pooped out on them the night before, having given away their rooms despite frequent updates and calls. And at 4 AM they settled on the one large hotel in the area- a familiar if expensive splurge.
It was amazing. Luxury in the middle of urban India is a hot commodity. We had midnight snacks but it was the breakfast the next morning which was over the top: above the city with beautiful views, excellent waitstaff and a full buffet with ordering options at no cost. (well, the hotel room was enough!)
We had to get out of town or we would have relaxed by the beautiful pool and I would have insisted on shopping (I missed out the day before!) although Lauren bought me a beautiful pink tunic with gold stitching to which I need sleeves added. Because of iffy internet, I will save before describing Vellore.
It was amazing. Luxury in the middle of urban India is a hot commodity. We had midnight snacks but it was the breakfast the next morning which was over the top: above the city with beautiful views, excellent waitstaff and a full buffet with ordering options at no cost. (well, the hotel room was enough!)
We had to get out of town or we would have relaxed by the beautiful pool and I would have insisted on shopping (I missed out the day before!) although Lauren bought me a beautiful pink tunic with gold stitching to which I need sleeves added. Because of iffy internet, I will save before describing Vellore.
Monday, March 26, 2007
2 weeks till departure
Am testing the new blog! So far have amassed DEET, light pants and sunscreen. Could be a fabulous, underdressed trip with only these items, but a few more still on my list...
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