Renu's Week

Sunday, November 29, 2009

Report of 30 Nov '09

Hello from the Banyan -

This is when it's nice to work for an organisation such as this. I walked to work this morning from the train station, through the giant non-Tamil speaking slum. The weather is cooler, and the residents have brought out bedspreads and such to cover themselves. I walk through and get to Spur Tank Road. Huts and temporary shelters on the other side, and on the river bank, have recently been cleared; residents have had to find other accommodation. I see a tent and a young lady near it getting thrashed by some people; a man is beating her with a stick, a woman is slapping her on the face with her bare hand, people are crowding around, passing comments, one man takes the young woman aside to try and keep the beatings at bay. I am riveted; I can't leave, and can't really plunge right in to this issue, either. Oh, can't I - I stop and stare, and manage to catch the attention of the male beater. I gesture to him in a classic Indian manner to ask, "What?" We meet in the center of the very busy road, and the man says that the girl is refusing to go to school and has torn up her uniform so that she can't go. I ask him why and he says, "Obstinacy." I suggest there might be other reasons, that he should investigate them at the school to which he says "No problem at the school," and I implore him not to hit her. I ask what he would do if she committed suicide, a not-uncommon phenomenon among young people here. And then I go on to the office.

I sms a few people frantically, and Vandana suggests Swapna. Swapna comes to The Banyan Centre (TBC), and we walk over to the tent. The girl is sitting there, eating, and the man is asleep inside. The girl is actually much younger than she had earlier seemed to be, and might be 9 or 10. Tent? It is a piece of tarp, slung over a tree branch and weighted down on each side with boxes. Swapna is magnificent: she asks the man why the girl won't go to school, and he suggests we ask her ourselves. So we do, and the girl hesitates. We then offer to take her to TBC to talk, explain to the man and to some neighbors what we are to do, and Swapna suggests that someone come along if they'd like. A little boy is sent with us. His name is KR, and he is 14 years old; he looks 8. He states he has been made to stop school by his father, that he actually enjoyed school. Both kids attended a missionary institution near TBC, and no fees were paid, the kids got food and drink.

Swapna talks extensively to the child, S, and manages to extract that S is actually quite a good student, but does not want to study any more, she wants to play all day. Her inspiration appears to be KR, who is an extremely happy kid, conveying every impression that his school-less status has led to this jolly state. Swapna manages to convince S to try to return to school for a week, in which time Swapna will monitor progress. We then bring the father, P, over for an update, the kids eat breakfast at TBC and fill their bellies, and a kind colleague gives them some chocolate; they are elated and want some more. We tell them regular school-going will result in more chocolate and they go on their way.

Have we saved the world? No. Have we made P's world just a bit better? I think so. It is nice to work with like-minded people who will save individual worlds.

The Banyan is doing well. Ms. S, our HIV+ patient with the broken arm, has been given a trial of rest to heal the arm. It is in a sling. Ms. S cannot be contained; she takes the arm out of the sling at regular intervals to wag it about and gesture to sympathetic fellow residents; she describes some process to all, using both arms exuberantly. As I've said before, she speaks a language none of us understands, and feels the need to gesture to get her point across; she also cannot be made to comprehend the need to keep the arm still and in the sling. I discuss this with the team, and we say surgery has to be the option, "rest" is not realistic with Ms. S.

I continue my training for the health care workers and last week, we adopted the case discussion methodology. We divided the group into 4 teams and talked about what they'd do if they found a Banyan patient down on the floor and unresponsive. The discussions were magnificent! A lot of thought, insight, medical curiosity and avid discussion - these young ladies so want to learn.

Oh, some fabulous interactions last week. My sister, Anu, returned from Boston, bearing gifts from our friends, Nina and Benoy Zachariah, whose daughter, Roshni, just graduated from MIT. Lindt chocolate - mmm, mmm. And a nasal steroid for Scott, which he greatly appreciates. The Zachariahs are close friends of many years, and Nina's mother, Leila Kurien, is also a very beloved friend, whom we try to see every time we go to Madurai. A very dear friend of 30 years, Monica Cooley, came into town and we met yesterday. Monica used to teach us ballet at Lady Doak College, went on to learn Bharatha Natyam (a classical Indian dance), married Mahadevan and now lives in Nashville, teaching Bharatha Natyam to all interested parties. She also came bearing chocolate, and dried apricots; while I have waxed eloquent about chocolate, my true favorites (mine and Navin's mostly, the others tilting the preference scale towards candy) are fruit, trail mix and microwave popcorn. Thus, we knew who'd eat the apricots and who'd eat the chocolate. Monica and we sat talking for a long time, and it was fabulous: she is a delightful, gentle, funny, sweet sort who can totally relate to both cultures and laugh out loud about the idiosyncrasies of each.

We managed to see my father briefly as he blew through town en route to an International conference in Delhi. Such glimpses are a treat. My brother, Vinu, met up with us then, too, and that was fun. Anu and family came in at a different time, and found a flat for my nephew, Aditya, in our building. All are happy at this turn of events.

The boys are fine, and are prone to occasional whining about academics. I have gently pointed out their good fortune in various areas. Ha ha - not really; not gently; I have pretty much ripped their thoughts out, pointing out that there are children on the street who would grab the chance to study but whose parents do not have the means, there are children who have to go to work from the age of 8, there are those who have sacrificed beloved academics to educate a younger sibling or get him/her married. Whining about academics? Look elsewhere for sympathy and a gentle viewpoint. :)

Unw -

R

Sunday, November 22, 2009

Report of 23 Nov '09

Hello from the Banyan -

The airconditioner is blasting and I should not complain - at least we can afford it, sort of. Actually, it's mainly on to protect our computers, as the intense heat and humidity of Chennai can cause many things to fold: Tupperware lids, Rubbermaid containers have not stood a chance here. Even the legendary, lifetime guarantee Tupperware.

Fotb.usa@gmail.com - if you want info on donating, and availing the tax exemption for it.

Ms. SA, the patient with the stroke, apparently opened her mouth last week when the health care worker (hcw) asked her. All are beside themselves with joy. I have not seen this miracle myself, but will ask for your prayers to aid in the recovery. Our triumphs are small, but they can be mighty. A colleague mentioned the hcw's little jig when the mouth-opening first happened. I have requested that someone read to Ms. SA on a regular basis, perhaps we can capitalise on her improving cognition.

Ms. S is a patient with HIV, and she speaks a language none of us knows. She developed arm swelling last week and was taken to the ER at the magnificent Sundaram Medical Foundation hospital, which treats our patients for free and does a very good job. The ER doc saw the swelling, apparently some discoloration (I had not seen the patient at all), pronounced it a skin problem and referred Ms. S to the skin clinic. Our very sharp nurse, Leela, continued to go after the problem and ordered an xray on her own; lo and behold, a fracture - which has to be repaired by surgery. I sent a note to one of my colleagues at SMF, asking for the thought process of the evaluating doctor, and got a reply within hours, promising more info. SMF treats our (impoverished, destitute) patients ably and like all other patients, and my intent was not to find fault but to help the evaluating doc realise that a swollen limb could benefit from an xray. SMF takes all such feedback well; some hospitals - and doctors - could get completely irate at the questioning.

A few days ago, it continued to pour buckets and as I drove home in the rain, an old man asked for a lift. I don't ever stop, but it was wet and miserable, and I thought I could take the old man on if something other than a usual car ride happened. The man got in, told me his health woes quickly, and I asked him to go to SMF, then he mentioned his financial woes even quicker and fairly brazenly asked for money. I thought of my purse on the back floor, but have long learned from my husband not to cough up bucks for every sob story, so my charity ended with the lift.

I caught a virus a few days ago, and it was particularly virulent. My throat worsened exponentially overnight, and I developed a fever. My suspicion was very high for swine flu, but treatment for that is a song-and-dance here: go to a special facility with about 1000 others, get tested and then get Tamiflu if the test is positive. So I gave up that quest, gargled madly with salt water, poured all manner of hot beverages down my throat, and felt better. The men were good during this time, and attended to my share of household duties, and made soup and tea, and listened to me whine non-stop.

One of my able colleagues, Swapna, sent our cooks for retraining to a wonderful local restaurant. They have returned with deft new touches to their recipes, and all are benefitting. I have thanked Swapna profusely for this brilliant idea.

My sister and brother-in-law came into town yesterday and it was good to see them. They were flat (apartment)-hunting for my nephew, a lawyer. Real estate in Chennai is very expensive, and that is dispiriting; I have seen a couple of apartments that I really like, and we simply cannot afford them. Why? - my own darn fault. Were I raking in the bucks in private practice, I could have afforded my dream flat with ease. And right along with that thought, my sons hug and kiss us as they say goodbye, instead of saying "Ewwwww"; one son says a bunch of his friends and he want to help at an underprivileged event and could I get more info on it; the other son speaks candidly of temptations he's tried with his friends and acquaintances; my husband entertains his in-laws as lovingly as if they were his own siblings; we talk on the phone with my parents as we plan for Christmas; we play games on Game Night, eat junk and laugh out loud at some ridiculous turn of events; all 3 men and I bring up issues of our respective days, we talk and laugh; I get a smile from a patient with no family and no money after she overcomes a disease. Do I have riches - not the flat kind, maybe, but certainly, plenty, plenty of others.

Unw -

R

Sunday, November 15, 2009

Report of 16 Nov '09

Hello from the Banyan -

I missed blogging last week. University College, London (UCL) and the Banyan Academy of Leadership in Mental Health (BALM) ran a course on Medical Anthropology, and I was deputed. I enjoy courses and conferences. This one was well-run; when it dove into anthropological and "high funda" terms, I was lost. Dichotomy, paradigm, etc. - these terms, concepts and what they were used to elucidate were totally befuddling. There was a session on Faith Healing which was excellent; the B brought patients treated by a faith healer, and a faith healer, and it was cool to listen to them.

It is my belief that I am of lesser intellect than someone who can confidently discuss esoteric concepts. Folks talked of menopause in Japan, that it was different from menopause in the U.S.; they discussed Indian scenarios and others; some got passionate about the role of medicine. Through all of this, I sat, contributing only when someone said she did not believe mental illness was stigmatised.

At the B, Ms. M had an event. She was being escorted back to her bed when she collapsed. I went to help her up with another patient's help, and she collapsed again. She then lost control of her bowels and bladder, and was unresponsive to me. As I felt her pulse, she started to gurgle, and spit up, and the moment of crisis was past. Another patient there tried to summon help, and was unsuccessful; the glucometer that is supposed to be present in the sick room was not; there was no powdered sugar on hand to put in Ms. M's mouth; all these are issues I am going to have to discuss when we get together with the team next. When the patient trying to assist me was yelling for help, I could hear the staff nearby in the dining room chiding her, asking her to contact the staff member in the sick room; there was none. You see, we cannot discount matters when a mentally ill person cries for help - the reason may or may not be genuine, but we must always err on the side of caution.

Well, Ms. M got better soon after some sugar was put in her mouth. She was back to her usual sprightly self, but we sent her to the hospital anyway to get evaluated. As I was squatting next to her, holding her very light head in my hand and near a smelly mess, I evaluated my role in the situation, being placed between Ms. M's life and death. This has freaked me out as a med student and intern, but has since become fairly routine. It is good to check our own pulse first, as they suggest in "The House of God," and try to stay calm through a crisis. Fortunately for me, Ms. M started gurgling and puking, and those were good signs. I did feel pretty privileged, though, to be treating someone who had NO ONE else, no husband/sibs/friends/parents, to turn to; is there Godliness about - I imagine so.

Our cook's husband, Mr. P, was unwell and they had tried to call me when I was at the conference. My phone was on "silent" and I did not hear it; the next day I heard that P had had fever and an upset stomach. I guessed he had eaten out, and he had; his wife lovingly packs a lunch, which he eats. He must have had a snack or 2 outside, and this was affirmed. In the monsoon season, contamination is rife, and eating out is fraught with more risks than usual. I sent the young man some antacids, Tylenol, and stern instructions about what to eat and what to avoid, and he appears to be better.

The rains are here. The slum folks have moved on to the railway station platform for a modicum of shelter. They do not speak Tamil, and I do not know where they have come from. It is not uncommon to see folks from other states here: we are a relatively peaceful place, with abundant religious tolerance, and a long history of hospitality. There is no dorm space in Naren's college, because young people have come from many miles away to study here; there are either no good colleges in their states, or violence precludes normal activity. Scott said the other day, after yet another bomb blast in Pakistan, that we think nothing of sending our sons by public transport, or out to gad about on their own. Blessings exist in many forms.

There were some fine times in the last couple of weeks. Scott and I went to hear a band cover the music of "The Eagles," and they were good. Navin joined us (Naren being off to follow up on climate change and Bhopal's 20th anniversary) to see a fantastic performance on dances of India - there are so many, and all so beautiful - by our legendary Kalakshetra, to raise money for marginalised kids. The boys and we saw some movies together. Yesterday, the men took turns to prepare the meals for the day and do household chores; this was the first time in my married life that I was completely free of household responsibilities and it was quite nice. Naren volunteered at a medical camp for underprivileged children, and discovered that it was being run by a friend of his, Archana. Navin is to volunteer for something similar in a couple of weeks. The great thing about such ventures is that a group of young people gets together, runs it, has jolly good fun hanging out together, and by the way discovers the fantastic joy in doing for someone much less privileged than themselves. Archana apparently sponsored lunch for all the impoverished kids at the camp, and Naren said there were so many other ways she could have spent her cash: iPod, a new outfit, CD's. I like the way these kids are choosing some of their friends, and their activities.

The big dilemma for me now is that one of Navin's friends strikes me as being not right for him. I have said it, Scott has requested me not to, and I am trying very hard not to harp on it. It will be a lesson for me in "Keep your mouth shut 101," which I have legendarily flunked.

Happy Thanksgiving to all in the U.S., and to all elsewhere, Happy November!

Unw -

R

Sunday, November 01, 2009

Report of 2 Nov '09

Hello from the Banyan -

The flower display - in a wide flower pot of water - has been replaced and looks lovely. I have eaten my 2nd breakfast and feel fortunate to be able to do that, especially when I have walked through the open-air slum this morning: the children ran about and played happily, but it was evident to me that there was no food in their bellies. You know something, though - that did not diminish their happy play any.

The Banyan has been doing well. Our health care workers (hcw's) are getting trained weekly. These young women are from very impoverished families in the villages around, and are great joys. I like interactions with them, and consider the work they do - be around the mentally ill residents 24/7 - to be very important. These employees are given room and board, which is a big bonus in our expensive city, so they get to save almost all their salary and send it home. They live in Adaikalam, so can't be too far away from the residents. Last week's training was on heart attacks, and was a raucous, interactive affair. I took some sweets that Naren had made, and the hcw's enjoyed them; I was then asked if I was grooming my sons for matrimony and I said, most certainly, I want my daughters-in-law to be grateful that these characters cook.

One of the social workers has just returned from a "rehab" trip - taken the well-recovered and functional residents back to their families, this time in North India, long train rides away. One of the patients, Ms. M, is a very attractive and personable lady. I found out from the social worker that on arrival at her far-off village, her mother had stated she did not want Ms. M back, and the team had no choice but to return with Ms. M to Adaikalam. Ms. M had, naturally, been disappointed but had recovered in spirit. I was very sorry to hear this story, that this patient's family had spurned her. How fortunate are those of us to whom this does not happen.

Some great times last week. There was a concert to promote climate change, organised by hordes of young people, and hosted by Naren and a young schoolgirl named Manavi. The music was good, and the info presented in a very good way, accompanied by yells of "We love you, Naren!" Navin came to the event with 5 girls. Yesterday was the complex's talent show, and the boys did not sing at all well, but ripped the stage dancing to a Tamil song - "Naaku Mukka." After the event, several neighbors said they were surprised to see half-White kids dancing to a filmi song, and with perfect Tamilian steps. It was great; we cannot listen to music without heads bobbing - or getting up and tearing the floor up.

We had a bunch of friends and neighbors over for "High tea," and Scott and I cooked the food together with the boys. It was a fun time, and the boys got lots of accolades for their parts in the cuisine.

Our cook's neighbor, Ms. K, has been taking her husband, Mr. P, regularly for reviews with the Banyan psychiatrist. Mr. P is back on his anti-psychotic meds and is slowly getting to functionality. This has apparently energized the other neighbors, who are now sending consultations to me through our cook. Works for me: medical attention in any form, if necessary, should be within reach of all.

Unw -

R