Report of 27 Mar '05

Could life be better? My handsome spouse is sitting by me reading the paper and drinking tea, clothes are drying on the line outside and the boys are trying to study for their exams. School exams here are very rigorous and the boys have spent a fair amount of time studying, to be fair to them.

We just saw the last of our brunch guests off. My widowed sister-in-law, Susan, and her kids are here; my brother, Vinu, and his family joined us; my sister, Anu, and b-i-l are passing through Chennai today en route back from Singapore (a conference) and my aunt and uncle joined us as well. It was lovely to have everyone here, and to get the cooking done ahead of time. (Our cook has elected not to return yet - I think she's a mite ticked w/ me b'cos I did not give her the hefty loan she asked for; so be it, I do have to juggle finances now.) Anyway, ostensibly, several factions of the fam are not totally at ease w/ each other and sometimes I get requests not to invite certain relatives, blah blah; I invite whom I want to invite, and enjoy everyone's company. Anu is expecting a professional contact today, whom she's going to work with; this man discovered that the mortality rate from suicides in Sri Lanka was reduced after he diluted the pesticides, which both Anu and I decided was brilliant. It is nice to meet others professionally, esp when they have such good ideas; I totally look forward to the conference of the American College of Physicians where not only will I stay w/ a great friend, we'll also hear some good talks.

Yesterday, as we were sitting down to a burger lunch w/ our just-arrived guests, the phone rang. It was Leela, the nurse from the Banyan. One of the patients there had just had her cataract operation done a couple of weeks ago and had developed a fever this week. I wanted her evaluated in the hospital, esp as she's a post-op case, and that was not done. When I returned 2 days later, she still had fever and was not better. This lady's uterus was almost completely outside her body (called "prolapse") and both the other doc and I wanted the uterus removed. The hospital had told us to bring her next week for the uterus removal ("hysterectomy"), and in the meantime she developed this fever. She was taken to the hospital this week and transferred to the ICU where she died. Leela was devastated and wracked with guilt; she felt the outcome would have been different had we sent the pt to the hosp earlier. I spent many minutes on the phone, leaving Scott to deal w/ rambunctious guests and the burgers, assuring Leela the outcome was not her fault; that this might have happened even if the pt had been sent to the hosp earlier; that I was calmed by the thought that the pt's last days were spent in warm and welcoming surroundings, that she was cared for by people who truly wanted her comfort, that she did not die alone and abandoned on the streets, which is the lot of many mentally ill people. I then asked Leela how old she thought the pt was (i think she was over 60) and Leela, in her mid-20's, said the oldest number she apparently could think of: "I think she was over 40, doctor." All my 41 yo bones creaked audibly just then.

Udavum Karangal is fine. They asked me if I could go for a Hepatitis B vaccination camp today. One of the greatest things about working gratis is that I don't have to go in on the weekends, and can enjoy the fam, esp my decidedly witty husband. So I declined. I did not feel one whit bad about it. Sailakshmi continues to come to UK and that is fun for me.

The tutoring is good. The students learn in Tamil, the local language, and none of us can read it well enough to comprehend the textbooks, so we had to enlist the help of a retired neighbor w/ a math lesson. Thank goodness she came through. The little girl who wanted math help said, "The teacher did teach us this, but I did not understand it." I was touched by her earnestness and her desire to learn; please, Lord, let us have this kid for a while, that we may educate her and tell her of her worth, that she may not tolerate a man beating her or her parents selling her into the sex trade, that she may earn as an adult and provide for her family as best as she can, that she never lose this desire to succeed.

We were at the beach yesterday w/ our boys and their cousins, and apparently some teenage girls placed themselves next to our boys, which Susan and Scott saw immediately but I did not as I was minding my 6 yo niece, Sanjana. These fellows had no clue and did not appear to care, but Anu's son said later that he was flattered. I loved the candor. As my niece and I waded, a little girl selling balloons came up; I said I did not want any, and she said, "Please, akka (a term of respect meaning older sister)." So I bought one. As I headed to Scott to get the cash, he told me that I was causing the child to be at the beach and not at home studying. I told the child what Scott had said and that he was angry w/ me, asked if she went to school and she said yes, she was in 4th grade, that she had not done her homework yet and then she started crying. It ripped me apart. When I was 8, I came home from school, had a snack (a mini-meal called "tea"), played cricket w/ the neighborhood boys and then did homework, ate dinner w/ my parents and sibs, and went to bed. This child was 2 years older than my niece; she could not romp in the waves w/ her aunt, she had to defer homework, she was cared for by adults who made her work and take money home.

I am aware that I have made various requests (help w/ locums, funding, booking tickets there when the Internet does not come through) of people and must apologise to you if you feel my messages are politically incorrect and that I am asking for too much. There is no excuse for offence and my sincerest apologies if you feel I am inconveniencing you. As I lay in bed one day and thought of the state of affairs here - no funding, no registration, no locums - I decided to stop feeling sorry for myself and headed to the Banyan. That always helps restore perspective. My registration may be getting considered - finally the Medical Council of India has replied, but there is much to be done yet sans bribing. This saga is just beginning, fully a year after I applied for registration.

Well, let me wind up w/ apologies again. Sometimes, this work is very isolating; it is, however, very rewarding and when the Banyan asked if I could come more often, I was phenomenally honored. As weird as this year has been w/ the lack of funding, regn, blah blah, it has also been one of the most fortunate for me as Scott got a job w/ Infosys (www.infosys.com), the premier IT company in India which has just been named India's Best Managed Company, among other accolades. As a spouse who put his career on hold for 8 years so that I could go to med school and finish training and then move to India to care for the abysmally poor, he is truly a pillar of support and someone I wish the best for, always.

"I feel a very unusual sensation - if it is not indigestion, I think it must be gratitude." - Benjamin Disraeli

Best to you,

Report of 20 Mar '05

Hello on Monday am -

I could not access Hotmail yesterday, to my chagrin - Sundays are a great day for me to write and vent and share. So this report is going out today.

Life last week started off well. Scott took Monday and Tuesday off, Tues being Naren's b'day, and I told the Banyan that I would not be in. Scott and I went out to lunch both days - eating out here is a big treat - and watched a movie, ran errands and generally did things by ourselves, sans children. It was pretty therapeutic and absolutely lovely. Naren's b'day was celebrated w/ a big b'fast and his opening presents: he wanted movies and his own room. He got the movies and some books. :) We cut a luscious cake in the pm; the bakery we get b'day cakes from does an excellent job, using real chocolate and the works, and they know it.

The patients at the Banyan are healing nicely; the woman w/ TB of the gut is now discovering a voracious appetite and we have placed no restrictions on her diet. She is about my height, 5'3", and weighed 35 kgs (77 lbs) at the height of her illness. She now weighs 44 kgs and I requested a photograph to document her appearance. I may just present this case at some conference because TB of the gut fascinates ME. The other day, she had not eaten b'fast and I asked why; she replied that it was a sweet dish and that she did not like sweets. The Banyan gets leftovers from a local company's cafeteria after their b'fast hours are over, and I asked the nurse if it was possible to get something non-sweet. It was produced immediately and the patient was profusely thankful. It was wonderful to be able to satisfy a need. After she ate, I noticed at one point that she was watching me keenly; I turned and met her eye and we exchanged a look - mine one of great gratitude and relief that she was healing so well, and hers one of some curiosity, I think.

Mentioning the chaos last week at Udavum Karangal worked wonders. This week, all the patients and files were ready, and I had about 40 people waiting. A pediatrician also came to UK; her name is Dr. Sailakshmi and she's a neat lady. Has lopped all her hair off, dresses in comfy non-traditional clothes, and wears no jewellery in a country where that defines a woman. She is passionate about care of the underprivileged, and aims to build a hospital; at the medical meeting I attended, a cancer specialist mentioned that the biggest prognostic factor in whether a child overcomes leukemia is the financial state of the parents - staggeringly sad, but true. We had great fun talking and connecting, including about the environment at UK, where there is so much centralised decision-making and worship of the founder. She is also comfortable seeing adult patients, and she helped me get through my clientele, as she had only 3 patients; I sure appreciated the help.

The tutoring continues well. 6 children come regularly, and the ones whose mother invited me to the ear piercing ceremony and got no gift from me have stopped coming. Some of the older children are pretty passionate about learning, and by golly, I hope we will provide some benefit to those who can choose this option over prematurely working or worse - prostitution.

The week was a bit brutal in terms of the number of No's that came my way - requests for funding have always yielded that answer, so that was expected; there are no locum (temporary job) opps yet and I have now publicised the fact that I'll even work gratis as I need precious U.S. experience (to keep the knowledge up) and references. I was so ticked one day that I sent off a politically incorrect email, prompting my husband to give me a bit of a lecture on sentiments in the U.S., etc. I realised suddenly that in my work w/ the enormously downtrodden, I work with so many folks who go the extra mile routinely (as you see above) that I have foolishly started expecting that in all my interactions. It was good that all this happened when it did, because it will reorient my thinking by the time I head to the U.S., instead of causing me to expect all kinds of help. Certainly, there are many, many people that go the extra mile for me in the U.S., and many of you are on this mailing list, but there are certainly many whose convenience must be accommodated also. I told Scott that if a piece of good news comes over email, I will outright faint. This is also as it should be, as it is causing me to find good news in my patients' healing, and my family.

Scott brought his American colleague to spend the weekend w/ us and that was fun. Matt is 22 (closer to our kids' ages, we realised!!) and very accommodating of Indian ways, food and culture. We were at the beach on Saturday and he was mobbed by a little girl beggar - yes, a mob of one. The other little girl who sells strands of jasmine there was particularly enthralled by a family's kite; it was a bright colorful thing which caught the wind nicely and bobbed along, and the little girl forgot that she was supposed to be working and sat down near the family to watch the kite. Rightfully so. The family, none of whose female members had hair long enough to wear the jasmine in, bought some jasmine from her - precisely what I'd have done. I thought to myself as I watched the number of child workers and vendors at the beach - how dare we forget what it is like to be a child, how dare we tolerate child labor, how dare we force a child to sell jasmine and not watch a bright red kite.

Ok, I am going to wrap. Any of you with locum ideas, pls pass them on; I do need to buff up my knowledge of Western medicine. Thanks.

"I'm tired of all this nonsense about beauty being only skin-deep. That's enough. What do you want, an adorable pancreas?" - Jean Kerr

Have a good week -

Report of 13 Mar '05

Ok, aol continues to freak out.

We are post-sleepover. 4 teenage boys, pizza, ice cream, movies, parents in bed by 11 PM. A soccer match this morning where Abacus won the championship, which we could not watch, as we had several folks over for brunch. Abacus winning a sport is big news as historically the teams have performed poorly. We watched the semis yesterday, b'cos we knew we could not watch the finals today and both boys and girls played well. A real tribute to the coaching staff.

The match was at the American International School, which very unfortunately is a reviled institution here. The annual fee per kid is $14,000 in a country where the average *annual* income is $500. The buildings are big, centrally a/c'd and all visitors have to park their vehicles outside the fortress-like walls. We have only been there for tournaments, and have observed their coaches correcting the refs, their staff yelling at visitors, had their Indian employees be snotty to visitors, etc. - sort of along the lines of employees at ritzy stores who can't afford the merchandise themselves being snotty to middle class customers. Scott hates the place. The teams also tend to trash-talk a lot, including use of the F word; Abacus kids state, tho', that the kids there are not bad. The teachers from overseas get 100% fee waiver for their kids, and Indian teachers get 65% off. A bit skewed to me, but most importantly, they don't appear to want to portray the best of American culture which I have seen and revelled in: the honesty, sense of humor, being super kind to all regardless of caste, the openness and friendliness, the generosity, the easy acceptance of others. The woman in charge of the girls' team was wearing an adult version of their uniform: a white skirt w/ pink flowers, a pink t-shirt w/ "Pink Mafia" written on it and two ponytails w/ bright pink ribbons; assuredly she would have been called "cute" by her ilk, but it sure stuck out in an environment where everyone is urged to act their age.

The Banyan is lovely. One of the founders, Vandana, is in the U.S. accompanying her husband to a trade show. She is great to talk to, and can be reached at vandana@thebanyan.org if you wish to speak to her. One of our pts w/ TB meningitis died last week. She was en route to the hospital and died. I remember her sitting in her bed and yelling to me, "Hey you there writing ... " You know, just the fact that these women are in safe environs, clothed, well-fed, is proof positive that the Banyan works. No one consciously worships Vandana and Vaishnavi, the other founder, and that is the way they want it. They eschew the limelight. We had another pt 10 days ago, who could only moan when I examined her. We are taught during training that a urine infection and pneumonia can manifest initially as mental changes, and this lady, whom we had to admit to hospital, does have a urine infn (let's hear it for training!). She returned last week after treatment, able to state her name, interact w/ us and eat ; unfortunately, she has also been found to have TB and is HIV positive. I looked at her as she ate hungrily, and hoped that the circumstances under which she contracted HIV were non-violent.

Udavum Karangal was a mess last week - late pick-up, no patients, no nurse on hand, no files. I mentioned it to the founder and he said he would take steps to avert this in future. The other employees seemed to mind my directness, but the founder did not, I felt. He is worshipped by many and I suppose I should also have been a tad obsequious, but I did not feel the need.

The tutoring was conducted by a friend last week as I was in PTA meetings. Both boys got decent reports from their teachers, to the relief of my older son who has discovered an audience for his American humor and his histrionics. I enjoy his jokes and his acting, too, but this is an intensely academically competitive country and I feel the child needs to balance those traits w/ some acad preparations. I taught sex ed at their school last week and appreciated the experience of opening young eyes to this arena. When I mentioned homosexuality, a young woman rolled her eyes, she thought invisibly, but the entire 9th grade has 13 kids and there was simply no option of invisibility here. We are to meet again, separately for each gender, and there will then be the opp for questions.

Naren's friend, R, lost his mother when he was 9 or 10 - 5 years ago; he was also here last night. The father is going through various struggles and is not looking to remarry, but mentions needing a female presence for R and that he likes our family. I do nothing special for R other than greet him at school and crack a joke or 2, but I suppose that means something to him - puzzles me. The father states that his family is estranged and that is a sad situation. I cannot imagine circumstances where my family and I would not want to see each other, and feel bad for this man.

I'd better wrap, otherwise this will become the next Ramayana (a most lengthy Indian epic).

"A man likes his wife to be just clever enough to comprehend his cleverness and just stupid enough to admire it." - Israel Zangwill

Until next week -