Report of 1 Dec '10

And 'tis the month of Christmas -

Hope all are well. I like this season. The festive air; spirit of peace, harmony and forgiveness; and the music, ah yes, the music. "Oh, holy night" is a particular favorite. I did not like the rank commercialisation of this holiday in the U.S., and the fact that folks went heavily in debt to "buy Christmas." My in-laws were very sensible about this: each adult picked a name from the pool of relatives and bought a gift under $25. Adults were welcome to get what they wanted for the kids.

Speaking of in-laws, Scott's uncle died last week. He was a very nice man. Scott said it would have been nice to be with the family then, and I agree.

The Banyan is good, as always. Ms. S, our deaf mute patient, continues to tell us that she wants to go home, we continue to tell her we need to know where that is. She cannot write, or read, and when I told her I needed the info, she went off, grabbed a pen, scrawled a pattern on her hand and returned to show it to me. I felt sorry. We have a long way to go to get this info, but perhaps our media friends can help us.

An English-speaking patient, Ms. T, is with us, and is in the sick room recovering from malaria. I looked at her file and saw that she'd quarrelled with her family and left about 7 years ago. There have since been romantic relationships, pregnancies and abortions, and most recently, 1 steady partner and a son. We have contacted her extended family, and they said they'd had no word of her for 7 years and would come as soon as they could; I asked Ms. T to please not fight with them when they come. She has agreed.

What manner of events happen, eh - fights enough to splinter the family, likely lack of recognition of a mental illness, the departure of a family member, sexual experimentation, thankfully now no dreadful disease to show for all this. I am grateful that my family endured all our teenage tantrums, and drilled it into our heads that pre-marital intimacy was a definite no-no. I am, indeed, thankful for a great many things in my upbringing, including my parents' neutrality: I know families where the parents go willingly along with their child's feuds with in-laws. Does not teach the child anything, except to continue pointless fights.

There was some fantastic news in the paper recently: Myanmar's Aung San Suu Kyi has been released! I was *elated*! The poor lady had been under house arrest, her white husband had died in the meantime and she could not go to the U.K. for the funeral, it had been 10 years since she'd seen her sons, had never seen her grandkids. All this because she opposed Myanmar's repressive, dictatorial, military regime, and won elections subsequently nullified by the ruling militia. I cannot imagine absences from my family lengthier than my usual overseas working stints. I am glad Ms. Suu Kyi is free, I hope Myanmar's condition improves.

The teenagers have been up to their usual shenanigans, including blatantly taking their father for a ride. Our dear friend, Mrs. Kurien, said at least 1 parent must be strict, so I have played Demon Witch Gorgon Ogress and instituted penalties. When one of the boys said earlier that I appeared to like punishing them, I said I'd appreciate nothing better than peace, quiet and kids who realised their potential. Someday, these characters might understand that.

I was in Madurai last week for the day, and enjoyed seeing my Dad. He had at least 3 appointments outside the house and kept all of them. I also enjoyed catching up with Mrs. Kurien in Madurai, and we had a nice gabbing session, with guavas and other goodies as accompaniments. Scott was out of town on Saturday, and Navin and I went to see a very good Tamil movie called "Nandalala." Naren joined us for breakfast the following morning and it was nice to see the boys, though shenanigans had ensued in the interim. I'll say this much: it is good to have honesty from the boys. We always know much of what they have pulled, though of course some will stay secret until we are 80.

Scott and I were at the beach Sunday, and it was extremely nice to spend time by ourselves. A pretty little girl came selling jasmine, and when I looked at her, I asked how long she had been selling flowers. She said, "I know you, you told me 2 years ago that I had to stay in school until 12th grade." We've seen this child before, and she is a cutie. I told her how glad I was that she was in school, and she said she stands second in class (Grade VI), which pleased me even more. I told her to consider college, and started to buy jasmine for 10 Rupees, but we'd left our money in the car and I could not. I said I'd catch her next time, she said okay and left; when I told Scott that she'd accepted my answer (of no cash) readily, he said, "She knows she'll see you again," and I said, "Yes, and I'll buy for 20 Rupees next time."

I love living here.

Unw -

R

Report of 22 Nov '10

Hello from the B -

And time is flying. I have not read any of my professional journals for the last 4 days and I feel the void. Family responsibilities and health issues have superseded much else.

I just finished a training session for the employees of our Day Care center. There is an urban center where family members of mentally ill folks drop off mentally ill patients. The employees wanted to know about first aid - very responsible, I thought. We did not stop with first aid; we went through the causes of why the heart would stop, prevention being better than cure, etc. It was nice; well-informed folks make our jobs easier.

The B is good. We have a patient, Ms. S, who greeted me with a big hug the other day. As I wondered about the sudden affection, I was informed that Ms. S had gone back to her family up North and then had apparently refused to take her meds, so relapsed and was brought back. She is much thinner, and while I think appropriate size is a fine thing, I am also reminded that many of our patients cannot afford food. When I give patients advice such as, "Try and give your kids an egg a day," I realise that it is not within many folks' budgets. And if I say, "At night, I need you to give hot water fomentation to your aching muscles," I often see that hot water is not within a lot of people's budgets, either. We must do what we can with what we have.

Ms. S waxed eloquent with what appeared to be a litany of complaints. I don't speak Oriya, our security guard does, so I took her over to him and asked him to translate. He said, "This is not Oriya," and then translated. I was puzzled and asked what was going on: he said that Ms. S was interspersing Oriya with something else, and then said, "See, since she is sick up here (pointing to his head), she says things I don't completely understand." However, he had done a fair job of communicating her message, and I told him to tell her that she would get her slippers and earrings back (the staff had put aside her gold earrings for safekeeping, as many things can happen with precious gold in crowded living situations).

One sick young son trotted back from the dorm with an abscess on his elbow. I became useful, suddenly :). We started an antibiotic, and I had him soak his elbow in hot water, and it was healing, then he went off and ostensibly waved the arm around, so it swelled up again. The following morning, I told him tentatively of the need to rest it in order for it to complete its healing, and then sat back and waited for the barrage of, "What do you mean, rest it? Do you know my play is only days away? How can I give up rehearsal?" Instead, there was, "Yeah, that was what my director said, too. I'll rest it today." The family picked me up off the floor, and I had to thank the director for his message. We are trying to negotiate similarly reasonably on another young man's academics, and that is a big challenge, also. He is capable of more, but the adolescent wiring simply prevents harder effort - boggles my mind. I asked the boys once why they fought with me, and not their Dad, nonstop, and one of them said, "It's hard to fight with someone who does not say anything." I should really learn from Scott, shouldn't I.

We attended a couple of concerts and enjoyed them, and took both boys out for lunch, since we had their rare presence on a weekend. The menu was Indo-Chinese food, the boys said it was too spicy for them, and I loved it. Conversation was involved and stimulating; the boys talked of how they declined offers to drink or smoke dope, and were left alone after it. When I expressed surprise, they said, "Come on, a billion people, they can find someone else to smoke dope with." They advocated legalisation of alcohol and marijuana, so that the temptation of forbidden fruit is removed, and we discussed that at length. I have to admit that there are very few young people hooked on prescription meds here, where they are plentifully available without a prescription, than in the U.S., where they are so tightly regulated. We also saw "Harry Potter and the Deathly Hallows," with a very rambunctious theater crowd, and enjoyed it in spite of the side bar chatter.

I talked to my Dad last week, and he spoke of having to officiate at some endowment lecture where the speaker droned on. My Dad and I are not fans of lengthy speeches, and we chuckled about this. Scott and I managed to get away on Bakrid by ourselves, and had a very nice day - lunch and chit chat, very nice away from parental pressures.

Unw -

R

Report of 15 Nov '10

Hello from the B -

Our car is in the workshop and I took the train today. 7.15 AM is reasonably the last train that won't be packed, though the 7.35 one is bearable too; I like heading off early, so these timings work for me. I took a 9 AM train once, after dropping off my visiting father at the airport, I think, and part of my bod was hanging outside the compartment; a fellow passenger looked at me with great concern and tried to squeeze me in, however, there are just so many sardines you can pack in a can. Overpopulation is alive and well in India.

The city is well-connected, though; sans car, all of us have managed to get where we needed to go, sometimes with a little getting up earlier, or walking some more, or adjusting responsibilities a bit.

I walked through the open-air slum to get here. It had rained earlier, and I imagine all the occupants scrambled to get into the station and shelter. The rain stopped by the time I reached Chetpet, and the slum folks were back in the slum. These are not Tamil-speaking people, and I think they are part of the vast migration of folks coming to Tamil Nadu to seek work: we are a safe state, thank goodness and knock on wood, with plenty of religious tolerance and a fairly robust economy. I did notice a non-Tamilian person begging at the station, and it is a shame that that is considered an option for livelihood. But let's not discriminate, shall we; there are plenty of Tamilian beggars, too. There was an article by Harsh Mander, a prominent social worker, in yesterday's paper and he talked about how wretched impoverished parents felt when they could not feed their kids. I understand this very well: when I watch the family eat, I am always eternally grateful that we can afford to. Even the dreadful mac and cheese, and the pudding that must be made from scratch (dissolve gelatin, boil milk, dissolve cocoa and sugar, mix the 2 liquids - milk and gelatin-water) give joy, and it's nice that we can afford the food we like to eat. I remember my mother and I sharing this sentiment.

When I crusade for women to limit breeding to 2, I use the example of breaking an idli (a steamed rice patty) into 6 pieces versus 4, and speak of how increased numbers of people translates to less food for each person. It's variably successful. Why don't I target men? It does not elicit the same response that targeting women does, as the Grameen Bank found out long ago: lend to women, they take care of the families; lend to men, not quite the same result.

The B is doing well. Our patient, Ms. Ma, was doing very well at work and has now had a relapse. She is belligerent, picks fights, is unhappy and not the same person she had evolved to be. She's the one who followed me into the sick room last week, and I asked for special permission for her to stay. An attempt had been made to rehabilitate her last year, and the team managed to reach her village and locate her family (no mean feat, I assure you - especially the long train journey, where the staff take turns staying alert even at night so that a resident does not get down at a station en route and wander off), and then the mother said she would not take her back. It was pretty heart-rending, and Ms. Ma came back thoroughly torn; the psychologists, psychiatrists, social workers and other staff worked overtime to reinstate Ms. Ma's self-esteem and I think it might be working. She must recover from this relapse of her psychiatric illness, and we can get her to be productive and happy again.

Productive and happy - the name of the Banyan's game. When we treat a woman's illness and give her earning power, all manner of happiness happens: improved self-esteem, self-confidence, a notion that she can solve her problems herself, take care of the family, etc., etc. Nice.

Navin's school trip to the hills (Kodaikanal) was cancelled due to landslides and so, he and Naren were coaxed to dance at our complex's Children's Day celebrations. I appreciated the accommodation the boys made, dancing to a pulse-pounding, joyously exuberant Tamil film song, and then Naren fled to act in his play. We had seen it earlier, and had enjoyed it. The boys continue to get into arguments with us with regularity, but I'd rather they do that and communicate and share, than do other things with their anger. We saw a Tamil film ("Mynaa") and had lunch together, and enjoyed that; as we sat talking over lunch, we asked our favorite water if we could dawdle a bit over the meal, and he said, "Of course, we close at 11 PM." And all laughed.

Unw -

R

Report of 11 Nov '10

Hello from Virus-ville:

Navin came home with "pink eye" (conjunctivitis or "Madras eye") last week, Naren caught it the next day in his short visit home and then Scott and I partook. No clearer evidence of age than this: the boys have been over it in a couple of days, and Scott and I are still dripping antibiotic eye drops in each other's eyes almost a week later.

But work has been fabulous - if my life span is 90, I do think I will work until then. The Northeast monsoon is here and as I got to the B one day in a very ethnicky skirt set gifted by Vandana, a car drove by and splooshed muddy water all over my outfit. But that was the least of my worries: we had to ensure that the monsoon did not yield gastroenteritis and malaria, and related ills. The emphasis on hygiene continues to exist at the B, so I think we'll be okay.

Our patient, Ms. M, says she is going home. She describes the village in some detail, and I ask with great sadness (as I know for a fact that Ms. M's family has abandoned her and there is no remote possibility of her going home) who is there: she describes her brothers and their wives and children, and asks if that is not enough. I cannot tell her she cannot go home, so I engage her in conversation and then she asks, as usual: "Are you married?" Yes. "Is your husband with you?" This is particularly wrenching, because her husband abandoned her and married someone else. I say yes. We talk for a few minutes and then I write in her file for the psychiatrist, psychologist and social worker to see her, to address this desire to go home. I wish more residents' relatives visited: it would assuage the patients and fill a need that we absolutely cannot, try though we may.

Our new patient, Ms. Se, is HIV+ and just recovered from an attack of leptospirosis. She is hard at work in the sick room; many of our residents are employed in various capacities and are paid. Ms. Se can apparently tolerate the bad mood of many a sick room patient and works non-stop. Sharon, my friend in Houston, had given me some fruit snacks and I took them for the children of our staff members; Sharon had also given me raisins for the B, which the Banyan residents and staff got. I love when friends give us treats for the B: they are so rare that they quite make the day for our residents and staff. There was a little bag of fruit snacks left, so I took it to the sick room; Ms. Se got one tiny fruit gummy. I asked if it was good, and she said yes. Another resident had followed me in to the sick room and would not leave, and I said it was okay for her to stay for a little while; she got a gummy, too, and said in Hindi, "I have not eaten a sweet like this before. It is so tasty." This is part of the reason I love working for the poor - one little treat, a tiny gesture, even just a smile and a greeting, and they become very happy. Ms. Se is a delight; in the midst of working, as I ask her if she has eaten, she replies - mostly with her eyes. She and I do not speak the same language, but communicate nonetheless; as I watch her work away, I realise that she left a husband and children, either voluntarily or was forced, due to her mental illness. I wonder, as a fellow mother, if she wonders how her children are, whether she hopes they are eating right and doing their homework, if their hair is combed and if her daughter gets the green ribbon that she so likes. But there is not a trace of sadness in her spirit, and she has made the best of her new surroundings (I am guessing this is better than the street), and smiles at me with her mouth, her eyes and in fact, her whole being. Very wonderful to see.

The Banyan Academy of Leadership in Mental Health (BALM) and University College London (UCL) conducted their fourth course together, this year titled "Rethinking Psychosocial Interventions in South Asia." I was deputed to go and was well enough to attend days 2 and 3. To sit in the middle of such intelligentsia, to listen to arguments and opinions and facts artfully said, all of this was a treat. Vandana and I were in the same small group, and as usual, I had to pick my jaw up off the floor after listening to her dissect a problem and offer a solution in about six sentences; truly heady to be in such august and erudite company. Mental health is not completely my bag, but I love learning new things and this fit the bill. I had to be very careful not to shake hands, but the evidence of my illness was writ large in my very puffy and red eyes, so no one hastened to touch me. :)

The boys are well. We have just had discussions with Naren about his love life, and then he has pronounced that he really does not want to come home for any great time over the holidays, as he cannot abide the rules here (Get up early, exercise, eat right), and wants to spend NY Eve by himself (not necessarily with the romantic interest - just away from us :) ). Candor is a good thing. Hurt can be a consequence. Adolescence will bring about an almost visceral need to hang out with "friends" in the holiday break. I messaged him later, told him he was welcome to his NY Eve plans, and said I would love him regardless of his choices, as indeed I will. Motherhood is not for the faint. Navin continues to consider academics a distant second over reading fantasy books and gabbing with friends, and I do hope his cosmos comes in alignment with ours at some point. Overall, though, it is good that the boys choose to communicate with us; they could be devising all sorts of alternatives to cope with teenage angst.

I talked to my father today, and he was surprised at UCL's choice to collaborate with us - "Oh, has the Banyan done anything worthwhile in the field of mental health?" Where has he been? He refers friends constantly to be treated by our psychiatrists, and then considers us some sort of random, earnest organisation with no success stories to speak of. It would be funny if it were not annoying. But really, it is better for us to be low-key about our many successes - if the residents are happy, we are happy.

Unw -

R