Monday, February 11, 2008

Out in the villages

Last week I rotated in CHAD- Community Health and uhh, something that starts with a D-
basically it is the part of the Christian Medical College (CMC) that does outpatient and outreach to outlying villages and rural homes

Seema and I went on "Nursing Rounds" with head Nurse Nancy, nursing student Pricilla, (lots of Indians, especially christian ones, have names much like ours!) and a driver. Somewhere along the way we picked up the community liason for that area, a women who started out as the birthing attendent or midwife of that area, who was later trained by CMC to be the health liason to that area, and to be a more educated midwife in an emergency.

So we set out in the car- really feeling like we were on safari , with holey dirt roads, speeding through an area with countless rices paddies, banana trees, cows wandering, goats playing, dogs napping, with the ocassional small house in the middle.

I noticed that many of the rice paddies had women dressed to the nines in beautiful saris, all hunched over in the knee high water, working away- so asked Nancy why it seemed only women worked in the rice, and no men? She then told me that men did the "hard labor", so mostly women did the rice- well, about 60 seconds later, after having seen easily 50+ women working the rice in that area, we came upon the men- probably 25 or so of them, literally laying on the ground half asleep in the shade, doing nothing!! The whole car got a great laugh over that.

So we went to visit a few women with newborn babies (I'm talking 5 days, or 10 days old), and the nurses spent time with them discussing proper care, feeding, diapers, signs of sickness, etc. Then we checked on a few women who were close to term, like 36 weeks and up, to be sure all was well, and the nurses instructed them about how to know when they should come in to the hospital.

Well woman and well baby check ups are nothing new for me, but the old fashioned feel of house calls out in the banana fields made it seem like I had gone back in time, we were even using umbrellas as parasols since each home was a good walk away from even the worst dirt roads, and the sun is really unrelenting out here in the afternoon.

Later in the day, we got down to some more depressing duties. We visited two elderly seeming sisters, who lived alone in a makeshift shack out in the middle of a field. They were both widows, and both suffer from seizure disorders. We brought them their medications, and the nurses had a long talk with them, as the younger sister was clearly malnurished. By malnurished, I literally mean she appeared much like the photos you see of starving people, like in concentration camps or african drought camps. She is shockingly poor, however, she was getting some rations from the government, as a widow. Unfortunately, as her husband had died a year before in an accident, and her only child lived somewhere far away and never visited or sent money, she was so depressed that she had been refusing to eat anything, and was literally starving herself to death in front of her sister, who was crying as she explained all of this to the nurses.

The nurses agreed that the woman needed to be admitted to the hospital, so they planned this with the sister- she would take her by bus (only a few rupees) to CMC and they would treat the sister inpatient.

Later, we went to a small village to do a death inquiry. The CHAD nurses and village liasons do all of the paperwork involving births, deaths, etc, for all of the villages. So we sat on the floor in a two room hut while a widow and her mother explained to us what had happened to her husband a few days before. The young couple, who have two children, came from another place to this village to attend a funeral of an old man. They came by motorcycle, as this is how most families travel, you'll see the dad driving, with one kid on his lap, with the mother behind holding another child! Funerals here are a celebration, with music, fireworks, and lots of revelry. Everyone follows the cart with the dead on it through the streets.

So the young father had gone on his moto alone to fill up gas, fill up a portable gas container for a friend's moto, and pick up fireworks for the funeral. Sadly, the festivites had already begun, so when he returned with a full tank, an extra portable tank, and new fireworks, some other had already been setting off fireworks, and a stray hit his gas tank, making all the fuel and firworks explode, with him still on the bike- as such, he had third degree burns on 40% of his body, and since he was on fire, no one would come near enough to help him put it out- so he ran to a pile of sand and put the fire out himself.

He died in the hospital 10 days later, after infection and organ failure set in. THe wife kept telling the nurses that the doctors had told her he would be fine and get better, but the nurse tried to explain to her that with burns of that magnitude, and considering he apparently had red urine for several days before he died, that he really never had a chance, and that she was sure the doctors did all they could. When the body was given back to the family for the funeral, all of the villager noticed he had incisions on his side, so, considering the biggest news story in India is not currently cricket, but rather a kidney stealing ring led by an indian doctor who stole kidneys from poor country people, the poor widow wanted to know how she could begin a formal inquest into the stealing of her husbands kidneys, as she was sure that was what killed him, not the burns. Nurse Nancy spent well over an hour with the poor woman, doing her best to educate her about how serious burns are, how a recovery (in India especially) was never really an option, and how her husband had been far to sick to be able to get usable organs from.

Once that conversation had taken its course, the woman then begged the nurses to talk to the village mayor of sorts, as he was refusing to give them the mans death certificate, which she needed to start getting widow benefits for her family. The nurses then explained to us that india is inherently corrupt at that level, and the only reason to have such a post is to get bribes from people, even a poor widow in these awful circumstances.

The last stop of the day was a gypsy camp, however, since these particular gypsies had been camped in one place over 20 years, we weren't so sure that this place was still a "camp"! It was a collection of makeshift huts, some made of rice sacks and tarps, a few with concrete walls and thatched roofs. All kids under 6 or 7 were naked, a slew of other young kids, 7-15 were running around, even though it was still school hours, and all the parents were just hanging around, seemingly doing very little. I gave the kids some crayons I had, and they went nuts, wanting more and more, but I had given all I had. All of the gypsies had dark skin, probably a biproduct of basically living outside in southern india, but many of them had haunting light eyes, a genetic remider of sorts that their ancestors spent time as gypsies far far away to the north somewhere before settling down here. As we were leaving the camp. a whole new batch of kids came running down the street- all wearing clothes and backpacks- I realized these were the kids that had gone to school- it was mabe a fourth of the kids in the little community. I wondered to myself if these motivated few would be able to perservere and stay in school, or if they would be forced into work or some sort of gypsy style scam by their parents. I guess I will never know.

Thursday, February 7, 2008

Interesting People 3- Titi

He looks at first glance to be a small framed asian teenager, maybe chinese, I'm not sure. I am just leaning against the garden rail, at the front of the hospital's main entrance, knowing I dont have to try to hard to look around for the people I am meeting- there are after all, maybe 20 tall european blondes in this town of more than 330,000, today.

I am waiting for my friends to arrive from Karigari, the leprosy hospital out in the country, 40 minutes outside the city. They are taking an autorickshaw all the way here to Vellore, quite a bumpy ride, especially with 4 passengers. Thankfully, one is Candace, tiny American, but two are very tall Eurpeans, at least they are very thin as well! Then there is Jason, the "native looking" Indian (translation, totally western dude of Indian descent, from Houston, who regularly says 'yall", and who decided to sport the "native look"- ie a serious mustache- while in India this visit) I'll get to them later.

So I am waiting, and the little guy I noticed earlier on my left is waving at me, and I realize he is also shouting greetings to me, in very good english! So I wave him over and he starts talking a mile a minute- he has a strong accent I can't place, but his english is good, really good. He says "where are you from?"- USA- (later on the trip I actually started to answer 'Canada' to that question, but not for the reasons you would think!) "What are you doing here?" - Medical student- "Nurse?" - DOCTOR- "Wonderful!! Are you a Christian?" -eeeerrrrahh yeah?- "Praise the Lord!!" (have I yet mentioned that this is the kind of guy who uses silly overused words like 'wonderful' and 'praise the lord', and you actually FEEL his enthusiasm- not like a televangelist, but like a really sincerely excited child?)

In little to no time, Titi and I had exchanged emails- I hope I can find it- and I had gotten his story- another amazing person for my growing collection of worldly friends. He is a missionary- well his parents are and he helps, he is @ 21 I think. He is actually from Burma (Maynmar), not exactly a hotbed for missionaries of anykind- mostly because they throw anyone and everyone in prison, pretty much for whatever they want. You speak about peace in Burma, you go to jail. I know this. I ask Titi if it is dangerous to be a missionary in his country, he says yes, but god usually gives them a way to get away when the government sends their people. He and his parents would not be hard to find, they apparently run a seminary for over 200 students.

The father has been to Dallas! He says there are "many good christians in Dallas". Apparently he has done work with Mission Asia (forgive me if that is a little off), and I think a man named Chuck Smith- I know its a sneader but I really think that was the name

About this time, his father and uncle come over. Apparently he was waiting for someone as well. Today, they had hoped his other uncle would get a kidney transplant. Unfortunately, the cousing who was to donate a kidney was not an HLA match. So the search begins again. No transplants in Burma, so they tried China, then the US, who sent them to CMC, because the cost is so much lower and the quality is on par.

But it turns out, he has been in Vellore for three months. He and his father came 3 months ago to CMC hospital hoping to find a liver donor for his mother. Sadly, 30 days before I met him, his mother was singing her favorite hym, singing on and on, for more than a half hour in her hospital bed, and after her favorite line, about finally getting to see god in heaven, she closed her eyes and passed away with her family around her.

This family I just met is telling me all about it, I give my condolences, but they are very sure she has gone on to a better, nay the best, place. There are no tears today. More greetings and salutations, as well as a promise to email the picture I had taken of all us- another unforgettable encounter.

Interesting People 2- Daniela

She is your typical German girl- blonde hair (natural no less), blue eyes, fair skin, fairly tall, speaks very good english, but with a lilty german accent. She is here for the second time, having spent several months here last year in the orthopedics department, and is back for another few weeks before going home to Germany to basically start her residency.

She is my age, so she actually started off in nursing school, but when she finished she realized she needed to go back and "do the doctor thing", much like myself. During her nursing education, she had a little old car which barely got her to and from school. This worked out to her advantage one day when she broke down on the side of the road, and a handsome young man helped her by towing her with a rope, all the way to a mechanic! They got married about 7 years later!

That is a fun story and all, but its the little things you learn about someone that really bring home the differences. Last weekend, all the Americans went home, but I stayed on for another month, so I spent most of my time with Daniela and Anarosa (said VERY german like AAnAAHouussen) apparently I am a great language mimick- I kept repeating their german words with little idea of what I was saying- all to much laughing- but what was really funny was that I had begun speaking MY English with a German accent, so they understood me better. Nicollette pointed out how strangly I was speaking when the Americans finally arrived! I also use an Indian accent when speaking to Indians in english- it just helps bridge the gap! Although I usually end up sounding an awful lot like Yoda (he is after all, my screen idol)

Enough of languages- so both Daniela and Anarosa grew up in Germany- East Germany to be exact. So as we layed out by the pool all sunday afternoon, there was much excitement about this watermelon they had bought off the street. They asked the pool restaurant to put it in their fridge to cool it off, so we could eat it later. I was thinking to myself, "gosh, these girls are getting REALLY excited about a piece of fruit". Then, as we finally decided it had been cooling long enough- we dug in, and as all watermelon does, it brought stories of Vodka soaking, summer camp (where they oiled up watermelons and through them in the pool- making us campers dive in and try to grab them out for cabin glory- looking back I realize it was just for the shear entertainment of the counselors and staff), and remembering what a BIG deal it was to get a watermelon, once a year, if that. WAIT, WHAT??? Oh yes, "we would get a watermelon once a year, not every year even, but we would get sooo excited". again, EAST Germany

I had a friend at school in Madrid, Elka, who grew up in East Germany, and I always remember her saying that Bananas were a big deal!! She had never had one until the wall fell, and then people were just throwing over bananas!! Watermelon was not on my list- considering that I met Elka in '99, and at the time she was probably already 27-28, thus around 18 when the wall fell- it was a subject that still came to mind when you met someone from Germany- East or West, then, what changed for you??

Here I am, almost 10 years later, being dumbstruck by that fact that two german girls are crazy excited over a watermelon- having almost totally pushed from my mind that fact that I grew up cheering for Olympic teams from US(if we got to go)/England/France/West Germany against the evil Communists of Russia/East Germany/Poland. Today I meet germans and my first thought is- " oh, I wonder what they will think of my last name?"

So, the watermelon led to some questions- what changed most after the wall fell? Well, they did not live in Berlin, so their cities didnt change quite as fast, but they both agreed being able to travel was the biggest change. That and watermelons, bananas, and all the other "everyday" things that were not produced in Germany or Russia, and hence, not availabe at all. Both of these girls went to university and medcial school in the "old" west- would they have been "allowed" to become doctors in the "old" east? I don't know. Daniela is 30- so she was @12 when the wall fell, therefore, she speaks Russian, as it was the only language offered at school. Anarosa is 26, so by the time she remebers school, they were learning English and French instead.

Interesting People 1- Vasi

She talks like a typical Australian, including saying "teli" and "loo", looks like a typical beautiful Indian girl, We met while we both worked in "OG" (Ob-Gyn to us), and it was fun to have her translate some of what the patients and doctors were saying! I only know "Mooka!! Moooooka Ma!! Moooka!" (aka push/empuje/mas mas/good job!)

Where she really gets interesting is in the non-chalant way she explained to me why she speaks Tamil- I assumed her parents were from Tamil Nadu (the state I am in here in India), but I was wrong- she is from Sri Lanka, where she grew up speaking Tamil at home with her mother, an Ob-Gyn, and her dad, a teacher. The Tamil speaking population is actually a minority of Sri Lankans, only @ 25%, but a tiny group of them formed the Tamil Tigers guerilla group, hence a war has been going on for 25 years now, and still makes the news in this part of the world almost daily. I vaguely remember a few years ago some "guerilla" group bombing all the planes on the ground at some Sri Lankan airport- but I had no idea anything about them.

So using the same tone of voice I would use to say "Well, I was born in New Orleans and then moved to Dallas", she says "Well, we had a really great big house with land, near where my parents grew up and they loved it, but one day the guerillas came and took over our house, kicked us out, and ate all of our grain and rice, so then the government bombed it, so we had to move to another city. But then our education was interupted, because our school was under a bombing threat, so they closed it for 3 months, and so my parents decided to move to Australia so our educations would not be harmed."

Are you kidding me? This whole crazy story, coming out of a totally stylish, westernized Aussie girl, with an accent which could do the Crocodile Hunter justice, grew up in a house, it got taken over, then bombed, then school was out, again for a bomb- so they moved across the ocean! My life really has been a bore.

Beach Weekend

We hit the beach this weekend, for a couple days of rest out of the busy city. We went to a beach town called Mammalapuram a few hours south, on the southeast coast of India, on the Bay of Bengal. This part of the coast was heavily affected by the 2004 Tsunami, but we did not see too much evidence of that in the small pocket where we spent our time. Our hotel was full of Europeans, which meant we were constantly bombarded with strange white people- sounds odd, but when you go three weeks without other "white" people, it is quite shocking to see. At the hospital, and on the medical school campus where we live, we know all the other Americans, Europeans, Australians, etc, and there are really only a few. Also, many of the British and Australian students are of Indian descent, or even grew up here, so that makes the numbers even lower. (we love those people because they can typically communicate better with locals, even if they only speak Hindi -they speak Tamil in Vellore, not Hindi- and they do great things like teach us how to use the local bus system, bargain with rickshaws, explain what we just ordered off the menu, etc)

Speaking of menus, I have determined that I really like Naan, veggie masala, parotta, dosas, and yes, Indian banana flavored corn flakes. There is actually a photo with me and my cereal boxes, as they are stacked higher the me in my room!

So, the sight of the Europeans was odd at first, but then it was just like any European beach, with men in speedos, even the oldest women in little bikinis, somehow miraculously looking better than most younger americans, and every child under 6, boy or girl, were just plain naked. I tried to make out the languages and came up with French, Dutch, British English, German, Italian, and either Swedish or Norwegian I think. And this is a hotel with maybe 50 rooms. They actually had a fenced in nice swimming pool- likely brand new post-tsunami- so we were actually able to wear bikinis by the pool, something you basically cannot do in India, women really cant wear swimsuits period unless they are at a very European resort. We can't even wear sleeveless shirts, and our ankles must be covered at all times as well- hence my new wardrobe of the long tunic with long pants outfits I have bought here- the pants, shirt, and a matching scarf, can be bought for @ $1.25 US! Amazing!

Friday, January 18, 2008

the leprosy hospital

I spent the day at a Leprosy Hospital yesterday, and it was truly an amazing, unforgettable experience. I decided not to write about it immediately, as I think I needed to digest it a little before doing so.

Short med side note- Leprosy is caused by a bacteria, but most people exposed to the bacteria do NOT get ill, only @ %10 or less of the population is genetically pre-disposed to actually coming down with leprosy if exposed, and true exposure is rare, even for those with close relatives with the disease- and its cureable- if caught early all is good, if caught later the nerve damage is irreversible, ( so if your hands and feet are totally numb- they will stay that way, but usually meds stop the disease from progressing)- an example of the worst form of the disease- if you have ever seen Kingdom of Heaven with Orlando Bloom, the young king who wears the mask has sever e leprosy- thus the appearance of his face, and the story of how the previous kings adviosr saw that the boy could not feel a bad cut on his arm, and thus informed him that his son had leprosy

Some History- there is still one hospital/home in the US for people with Leprosy- "Leper Colony" is an extremely offensive and very politically incorrect term I learned- in the US in Carville Louisiana, where, even into the 1950's, patients arrived from all over the US IN CHAINS, like prisoners, even though their only crime was suffering from leprosy

Families traditionally disown children/siblings/husbands with the disease, so the leprosy hosptals had a sort of multiple use as a place to get treated with meds, have any corrective surgeries which may help the patient function at a better quality of life, learn ways to prevent further damage to their numb limbs, and then, a home for them to live in and a community safe from prejudice

Even though the main medical center here in is the middle of a nice size city- the hospital for leprosy is a 45 min bus ride into the country, as no one would allow a leprosy hospital near their homes in the 1950s when it was built. THe buses which take people to and from the compound read "Leprosy is a Cureable disease" on the back. There is an interesting connection between Leprosy and advanced Diabetes- no they are not related at all, but research for one can benefit both, as the mechanism is totally different, but the end stages of both diseases have patients unable to feel their extremities, which leads to injuries, blisters, ulcers, infection, and evenatully amputation, whether at the hands of doctors or (I'll stop there as some of you really dont want to know what can happen to hands and feet with leprosy)

The scholarship we all got from our school to come here is named after Dr. Paul Brand, an orthopedic surgeon who basically changed the way leprosy was viewed, proved there were many methods to help and even cure the disease, and gave his entire career, both in India and Louisiana, to bringing people with leprosy back into society as functioning human beings, instead of the "untouchables" they had been throughout history.
example of surgery
a person cannot move or feel their thumb on one hand, so cannot grip anything/work/eat/etc., so the patient is told to practice moving his ring finger up and down, for a few weeks, to strengthen the tendon and muscle, then, the patient has surgery, which detaches the tendon of the ring finger (but NOT from its nerve supply), and attach it to the thumb, after a few weeks in a cast, the patient is told to move his ring finger like he had been, but when he does (his mind tells his finger to move), the thumb moves in its stead, as it is now connected to that tendon's original nerves, but has a whole new location! So the patient can now grip things!!!

Physical therapy and Occupational therapy really become the major factors in the quality of life of a person with leprosy,
example of this-
since fingers get contracted into "claw hands" with no extension, special excercies and braces help stretch out fingers if caught early enough
always wear gloves or use a special cup holder when handling hot coffee or tea- its served HOT here- to prevent injury/blister/infection/finger loss
if fingers are already lost, they are fitted with special straps for their palms for using forks, toothbrushes, etc.
each patient can have very special shoes made, they are really prosthesis of varying degrees, depending on how much of the limb is lost-I have pictures of this I'll send

There is so much more I could say- but I'll wait until I have some pictures- and I'll include a warning for the really graphic ones for those of you who really can't stomach that sort of thing

Monday, January 14, 2008

Culture Clash, World News, Ob experiences

A big part of the Indian "experience" is had just outside the hospital complex gates, on the main shopping/bazarr area called Ghandi Street. I am loving the fact that I can go buy 4 amazing Indian outfits (all for a good cause- none of the clothes I brought for work actually cover my ankles, as they should) for a grand total of $5, but after reading in the Indian newspaper about "Eve Teasing", we have all agreed to 1. not shop alone, and 2. leave Ghandi street before dusk.

Even though the street is chock full of people, including families with babies, until well into the night, it is traditionally "innappropriate" for a female to be "alone" in public- I thought that was ridiculous, as there are 100s of women walking all over all day long- but I realized they are always in groups of 2 or 3, even as they walk to school. "Eve Teasing" is basically a male/group of males who harrass young women who seem "alone". Well, today, with 2 of us, in broad daylight, and at the hour that the street is teeming with hospital staff as well, we were simply running by a store to pick up a shirt we had tailored (you have to ask a tailor to attach sleeves to your shirts, even though all shirts have sleeves here, you dont attach them until the shirt is bought?)

It was only 5pm, not even close to dark, but I stopped in a shoe store on the way to the tailor, but did not buy anything as they did not have my size (all of these "stores" are simply open booths on the street). As we continued down the street, I noticed one of the shoe salesman followed us to another shop, and then another, another, then another which was actually an air conditioned inside store, then to the tailor shop (the tailors are these 2 very old, sweet english speaking men who we love) which is up an open flight of stairs on the street- I chose not to point this out to Kristen at first, because I thought she would freak out- and we were very much in public, surrounded by people of all kinds, and he was keeping his distance- sort of,

we went to a nearby store where we knew the man (having bought several shirts from him) and asked if he would tell the man to leave us alone, but when he looked up, the man walked off, but then reappeared. Then we headed to the infamous "4 full Indian outfits for 200 rupee" place I had found, the source of all of my ankle covering coolness, where not only do I know the men who work there (as I must be their best customer this week), but they were having a street sale so women of all ages were throwing elbows and yells- on our way in I decided I had to tell Kristen, at which time she totally freaked out, and started getting all belligerent saying "what, what!!! I'll beat him up!!! If he so much as touches me I'll hit him so hard he wont know what happened!!!!"

UUhhh, that was why I hadn't told her in the first place. So when I realized she was 1. dead serious, and 2. obviously considering going out there to do it, I knew I had to do something before the strongest little 90 lb American track star firecracker ran into the street to punch out this creep of an Indian dude- and thus get us subsequently acosted by an angry mob- so right then I just looked right at him, and he looked stunned, as I had pretended not to notice him until now- and screamed bloody murder for him to go away- so he got the message, but most people on the street could not discern my particular yell from all of the rummage-sale crazed ladies all around me!!! ( thankfully, women of all cultures go bazerk over a good sale)

The only other thing about Ghandi street that is hard to adjust to, is the beggars. Old women, old men, missing limbs, kids without functional legs scooting around on hands, anything you can imagine, is there. Beggars are so sad, but you immediately get used to simply ignoring them, as the locals do, because the locals frown greatly upon giving money to beggars because it perpetuates the practice, and makes parents keep kids (especially female) out of school in order to make money- speaking of girls, we had a pre- eclampsia patient lose a baby today, (long medical explaination, baby had no chance here in India so not quite as sad as it sounds, quite), and when the indian dr saw it was a "female baby", she sadly said "At least to these people losing a girl is much less of a heartache than if it had been a boy"- I find it so hard to rembember that so many cultures still consider females as lowly creatures, but somehow, knowing that was their culture, I still took some solice in the fact that this girl could see something positive, even if it was that, as she had carried the child for 25 weeks before falling ill.

As for whats going on in the rest of the world, Indian people are so much better at keeping up with and discussing current events and world politics than the average american, in my experience. I have been reading the paper everyday here- and their coverage of US and world politics is very interesting- its fun to see what makes the news here- cricket cricket cricket, Bhutto, cricket, Calcutta bazarr burned to ground, cricket cricket, Chinese soldiers keep incurring into India at the border, more cricket, Obama, Hillary (Sir Edmund Hillary that is, RIP), cricket, Hillary Clinton, cricket, crooked cricket umpires, multiple attempts on lives of Sri Lankan and Malaysian high officials (the Sri Lankan rebels are "Tamil Tigers"- I am living in Tamilnadu- Indian state of Tamils, with Sri Lanka a few miles off coast), cricket, Bush, Australian Open tennis, the evil evil Australian cricket team, AND the new Governor of Lousisiana being an Indian American guy!!!

honestly, I left out about 20 "crickets" and a lot of slurrs against Australians, if I were really trying to give an accurate appropriation of newpaper space, but Im sure you got the idea!!!

My next blog I will try to focus more on some amazing medial experiences, today I actually saw several things I had only read about, really things I guess you hope to ONLY read about, since we also saw a uterine rupture which happened at home, so overall it was a very sad obstetrics day, and I'd rather not go into detail about that, but as you read this be thankfull that most of you have quick access to emergency medical care, and even here in Vellore, where the medical care is on par with the US, only 25% of pregnant women deliver at the hospital, and often only come AFTER there is a complication, after seeing what I have seen today, I will seriously have to consider what I will say to future patients who want to birth at home or at a non-hosptial "birthing center". I can tell them about today, but I will never be able to do it the justice it deserves.