Report of 26 Feb 2012

Hello all -

I had a couple of other things to do yesterday, and did not write. I had an 11-hour day today, and am tired, but writing is therapeutic.

The best thing happened to me today. Ms. J, one of our former patients, returned to visit. She has healed nicely, and runs a little clinic in her village. She treats patients for standard illnesses, and has had some nurse training, so functions as a nurse pracititioner/almost doctor. She brought a log of patients, their complaints and her treatment, and she was spot on in her management. I was pumped! She does this for almost free, and for the poor in her village, wanting to continue the service ethos of the Banyan, and is struggling to pay the bills. She has since established a trust to start an old folks' home, and brought the paperwork to show Vandana. I was impressed, and said so. I told her when time permitted, I would show up at her new facility, whenever it was built. It would be cool to work with her, she was our nurse when she was here and was very good at what she did. I gave her a little cash, Rs. 1000 or $20, and she said it would buy plenty of medicines. It was sweet - she is struggling to pay her own bills and gets excited at a donation because it helps her buy more supplies.

At this point, I want to say that if you want to help this effort, even $5 or 5 Euros or 5 pounds goes very far. A patient who healed with us and has since gone on to treat the very poor herself, is making a solid statement that I think merits encouragement. If you are going to send cash, please wrap it in a plain sheet of paper first so that it is not visible through the envelope. Cheques/checks are best (yes, for $/Euros/Pounds 5 or above), and are to be made payable to Jackulin; her address is:

Jackulin Sagayarani
South Street, Kovanda Kurichi Post
Pullambadi Valley, Lalgudi Taluk
Tiruchi District - 621 711
India

I can think of nothing better than the look on Jackulin's face as the checks start landing at her tiny house-cum-clinic, and she can then go on to do more, for more. I won't know what you sent, but she will benefit greatly from it.

The B has been fun, and the patients are healing. One of our patients had been in the ICU and very, very ill with pneumonia. The docs had done a tracheostomy (put a hole in her neck so that the ventilator could be hooked up to her windpipe) and had almost given up, but she has healed and is back! All of us in the health care team were thrilled to see her. She continues her usual chatter of her mother and father, and we are delighted to hear it. Honestly, this is a great place to work where we rejoice when one patient beats the odds and returns to us.

Training has gone swimmingly, and the ladies are learning. One day, one of them said, "I know you've talked a great deal about diabetes, but I don't know how one gets it." Get this - the others in class answered! "Well, it's when one becomes obese, and neglects diet and exercise ...." It was magnificent! It is wonderful to work with and teach such interested learners.

I was in Nagercoil last week to see to some business. My grandparents used to live there and their house is beautiful and old-worldy. I got to see some relatives, and that was nice. Ngl has great weather, and I walked quite a bit, and then took a train back to Chennai, falling asleep at 8 AM and only awakening at 4-ish AM.

Naren, Scott, Navin and I Skyped and we talked about the boys growing into adulthood and needing to execute adult responsibilities. It was a fun session, with lots of laughter and humor. The boys are trying to cope with responsibilities, but not without a fight. I suppose it is good that at least we get to hear about their angst, instead of their using other means to cope.

Naren and I saw "The Artist," and I found it boring and over-hyped. Scott told me today (he, Navin and I Skyped) that it won a slew of awards. Oh well. I am probably one of 2 people ever that did not like "The English Patient;" my friend, Tori, is the other.

"Opera is when a guy gets stabbed in the back and instead of bleeding, he sings." - Ed Gardner

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R

Report of 19 Feb 2012

Hello from Chennai!

Today's dark clothes laundry day and some heavy jeans and brightly colored cotton towels (I do love bright colors) are hanging on the line. Hardly anyone owns dryers here, as the sun does the job for us.

I am now licensed to practice medicine in India for gain (rather than just charity care), if I want. A friend's mother asked if I was going to try and get a better job; I stated there was no *better* job than the Banyan, and perhaps the goal to find something more *lucrative* ought to set in. However, I can write, and teach, and dance, and practice medicine at the B, and I think a more lucrative job might put paid (an end) to the non-medical activities. On Wednesday, my work-from-home day, I was feeling under the weather and as I plopped on the sofa to take a few extra minutes of rest before I started work, I wondered if I ought to feel guilty. And then the thought vanished as I wrote and answered mail and prepared training material.

Ms. E ran away last week. She stated that it was her son's b'day, and though neither boy has been located, she wanted to buy some sweets (candy). So the social worker wrote her a gate pass, a permission-to-go-outside slip. Ms. E vanished and did not return. In the evening, some of the B staff went to her old haunt near a local market and found her and brought her back. The next day, as I was teaching, I heard yelling and wailing; the staff enlightened me that Ms. E was in isolation and protesting. They mentioned her going to her husband and I said I thought he had died; the psychologist said there was doubt that there ever was a husband and now doubt that there were children. Investigations are on. I know little about psychological conditions and psychiatric illnesses, and perhaps it is not unheard of to imagine/halllucinate a family. I felt sorry, anyway, and am glad Ms. E is with us now; I don't think she was as glad, that day, but perhaps as we treat her illness, she will become more aware of her safe surroundings.

It is wonderful to have family support, isn't it. There have been times when I have felt myself coming unglued, and either Scott or the boys would help glue. Other times, a phone call to extended family - or friends close enough to be family - sets right the cosmos.

One of our senior health care workers is engaged to be married. It is an arranged marriage, and Ms. K explicitly asked for a groom working in Chennai so that she could continue working at the Banyan. Very few young women can really make such demands, but her family listened, the groom works in Chennai, and Ms. K will continue with us. Joy! She is a very nice and competent young woman, and I took some sweets for all to celebrate her happy occasion, the happiness for me being that she will continue with us.

Kovalam goes along well. A city bus (the public transport bus) driver came to be treated, as he had fallen and scraped his elbow. I cleaned the wound and dressed it. He then told me about other conditions in himself that were not completely clear to me and I asked that he bring his old records. He stated he would and told me he'd take leave to come and see me. I said that was unnecessary, and we could (I so hope!) finish his next visit in 15 minutes. I think some of this will involve my deciphering other providers' handwriting and that might or might not be time-consuming; let us see. I rather like treating simple wounds; the body does much of the healing and I like the process. The doctor might get much of the credit for the healing, but what the heck - I suppose that's inevitable.

The older man with the injured toe came to be checked and he is better! He had indeed come for daily dressings. I poked and prodded his foot and there was no pain - halleluia. His blood pressure was also normal and I was relieved, as he'd have to take bp meds otherwise, and those are currently beyond his budget.

Training at Kovalam was non-existent as nobody showed up at starting time, and offered me no explanation. So I walked out and took the bus home. I emailed later, discussing the situation with the person in charge and the higher-ups, and ostensibly, the staff had been occupied with other work; I mentioned the simple courtesy of keeping me informed as well as a myriad other forms of showing respect, and we hope for a class next week. A 30-minute class often lasts 90: there are so many questions and the staff are so eager to learn that I don't feel I can shut down and announce, "Well, that's that, then, I have to leave to beat the traffic." This is one of the joys of teaching: a bright, interested and motivated crew.

I went to Madurai this week to see my Dad. He normally sends the car to pick arriving travellers up, but he has dispensed with the driver as my Dad hardly goes anywhere. I took the bus from the train station and got home in 20 minutes. As I walked down our street to our house, an autorickshaw (a 3-wheeled mini-cab) driver who has known the family since I was a teenager (many, many moons ago) stopped to chat; "Well, Renu, you look pretty dried up. Let's go have coffee and 2 vadais (deep-fried savory lentil donuts - pretty darn tasty, natch, given the 'deep-fried' part)." I declined, but we chatted and then one of my Dad's employees walked up to say my Dad was sitting up waiting for me. He normally starts his day late, having retired, but was up at 0530, he said, as I was coming. We talked and talked, then showered, and ate breakfast and talked some more. I like hearing about his and his brother's days (his brother was the class and college clown) in med school - among other things - and we spent some fine times reminiscing. I went with him to a clinical meeting, and enjoyed it; the topic was treatment for fractures in the spine and it was cool to hear the presentation.

My Dad's cook (the country is overpopulated and it is very common to have cooks and maids and drivers) has had a baby girl, and the child is a fat lump of adorable and joyful. The cook, Ms. A, was sent to work at a very young age - I think 10 - and her parents tried to live off her salary, verbally and mentally abusing her in the bargain. She came to us as an older teenager and has been at our Madurai house for about 10 years now. My father's friends suggested matrimony to a young man, the 2 got married and are very happy - thank goodness. It is nice to see Ms. A finally have some happiness in her young life. She is a doting mother, and the lump is too cute; as a friend said of her own healthy daughter, this child has met no food she does not like. My friend, Kris Rea, had kindly passed on some of her own daughters' very cute clothes, and this baby benefited. I'd bought an outfit in the U.S. on my last shopping spree, very happy that I was finally buying for a girl. I like the fact that my sons are normal and healthy; shopping for a girl, either this new baby, or Aishvarrya, is still grand fun.

My father left for a conference in Thanjavur and I visited a respected and beloved professor, Ms. Nagammai, at my alma mater, Lady Doak College. Ms. Nagammai is a dynamic and bright professor, and she became Head of the Department ("HOD," or Chair) in her mid-20's. It's always a treat to see her, and we talked and laughed and reminisced. I then went to the cemetery to pay respects at my brother's grave. That was not as therapeutic as it has been before, probably because I had other things to do, and a train to catch. I had dinner with a dear friend, Mrs. Kurien, and that was fun.

The Banyan's revered and beloved senior trustee, Mr. Vellodi, passed away 2 days ago. The funeral is tomorrow. Mr. Vellodi was a career diplomat and turned to social work after he retired; he said he enjoyed social work much more than his other career. He was personable and charming and fun and funny; I will miss him, as will the B.

Scott, Naren and I skyped today; Navin was at a movie. It was fun to talk and laugh. All 3 men have fine senses of humor, and I have revelled in that for a long time now, my great good fortune.

"Wit is educated insolence." - Aristotle (384-322 B.C.)

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R

Report of 12 Feb 2012

Hello from sunny Chennai!

There is a bright yellow with-green-writing Ronaldo jersey drying on the balcony. It was gifted to Naren by some delightful boys from Brazil, who spent some time in India with their parents and lived in our apartment complex. When I first saw them - with piercings, etc. - my first thought was, "Hmmm, got to keep N and N away from these guys." Then one day, Naren invited them to play soccer. Pedro and Felipe were around our boys' ages, did not speak a ton of English, my sons spoke no Portugese, but all communicated. And P and F were just delightful: taking off footwear to enter our house (Indian custom), being very solicitous of their mother at our parties (she spoke little English), and being very appreciative of their time in another land. They were also good-looking young men, and attracted the attention of quite a few of the young ladies here.

Happy times.

The Banyan, as always, has been fun. I read a quote one day that I shared with Naren: something to the effect of, "Power and money don't matter; what you do must have you flying out the door each morning." That, indeed, happens; mostly to beat the traffic, but I do work at a happy place. Our young ex-sex worker patient, Ms. E, has been unusually out of sorts. She came by my room one morning dressed in blue pants with white dots and a black and white striped t-shirt; instantly, our nurse said, "Didn't the senior coordinator tell you to change your clothes?" Ms. E vanished. A little while later, she trotted by in the same outfit to wait to be interviewed by visiting social work or psychology students and when I mentioned the need for change of clothes, she turned and replied frostily: "One wears what one wants, this does not have to be dictated by someone else." Which is very uncharacteristic of her. I asked some of the senior staff if she was ill, and they said they'd look into it. I do know that the social workers have tried very hard to find both Ms. E's sons, last seen at a local orphanage, and they have not had much luck. Not being able to see my family would certainly put me in a very bad mood. I'll find out this week if there is something else up with Ms. E.

One day, she came by with make-up. It was obvious that her training had been to use make-up to attract, and not necessarily to look pretty for herself. I was sorry. I looked at this young woman sold into the sex trade by her *brother* - and felt for her, and felt much relief that she was now with us. She is usually a cheerful, hard-working sort. One day, she had to tote some heavy things and used a turban to cushion the weight on her head; she looked great - tiny, happy, turbaned! That's the person I want to see again.

Ms. K, our employee who had a urinary tract infection and is now better, had a relative die of cancer. She came up to me last week, gestured to the medicine I had prescribed for her, and said, "This worked, do you know. I thought I had cancer and would die." So I told her some of the signs of cancer, and said she needed to come to me right away if she had vaginal bleeding. We chatted for a little while, which seemed to reassure her, and then she toodled on. One of the Banyan cooks promptly came by with 2 idlis (steamed rice cakes) and some chutney on a plate and urged me to eat: when I lose weight, it goes first from my face and the upper half, and I think I must look decrepit. Prompting every hospitable Indian (and there are a billion of us, literally) to try to feed me.

Kovalam is splendid, and the older man with the injured toe did not return for daily dressings. It is common for patients to misunderstand directions, he said he had come and was told not to come daily, but to return a week later, and I have no earthly clue who communicated what; at any rate, we dressed the toes again, and I asked that the nurse give instructions in writing. He does read, as do his family members and I am hopeful that improved understanding means increased compliance. Another patient, waiting to see the psychiatrist, came in complaining of back pain and I urged physical therapy; this is to be done at a local hospital and she asked how she was going to get there. This is one of the problems with free service: the patients then assume that we will take care of everything, including transport for other therapy options. So I said very carefully that we could not pay for that transport and she may have understood that. Or not.

Training at both sites goes along swimmingly. The ladies sit there and soak up every word, and do manage to answer questions. The session is supposed to last half an hour and often goes over, as everyone has tons of questions. I love this! These poor (literally, poor) women have had to give up education due to poverty, and their innate curiosity and love of learning have not been dampened. So our sessions are lengthy, and interactive, and full of laughter and sometimes, treats. My friend, Olivia, had sent me 3 boxes of Red-hots and they did the rounds last week - a nice candy.

(I will assure you that if trail mix or favorite candy shows up here, I will definitely dip mightily into it also before I share :). But the sharing is grand fun.)

We also got a wonderful present this week. Lisa, one of the med students visiting from Texas, sent copies of pics they had taken. There was enough for each of the subjects in the pics and the photos generated much joy! They are rare commodities for our patients, and everyone exclaimed over how lovely they were, appreciated Lisa's kindness, and told me to be sure I passed on their individual thanks to her. A nice, happy buzz hovered over the Banyan that day. It is a joyous place, I tell you.

Naren and I got to see a concert featuring a reunion of a former student band that used to do covers of Simon and Garfunkel; Crosby, Stills, Nash and Young, etc. The event was sold out, but Navin's friend sang in the accompanying choir and she got me tix. I tell you, do you see where the connections are coming from: our kids! The evening was magnificent - I *love* covers, especially of songs I know - and I had to try very hard to keep from dancing. As the Y poster said, "Don't give me people who want to dance, give me people who have to dance." Naren said he did not want to dance, and really, upping and jigging right then might have been more of a spectacle than we wanted. So we danced at home, which we do fairly regularly. Poor Scott obliges me nobly, though he hates to dance.

Naren and I also got to eat at a Greek restaurant here and the salads were fabulous. The meal was slightly pricey, but I can pay any amount for a good salad. I don't think we can afford to do this more than once a year, and we enjoyed the meal. As a friend sweetly said to me of Solomon's blessing, "Happy is the one who wants what he has." Too true, Naren and I thought, as we revelled with gratitude that we could afford the foods we like to eat. Naren then drove me to do our weekly grocery shopping and at the produce shop, where all of it is very fresh (as I have mentioned before, our refrigeration techniques are poor - thank goodness), we bought 9 types of fruit: 2 types of oranges, sapotas, saathukudis, apples, bananas, guavas, pomagranate and watermelon. We had some of it today and loved it. One of the employees at the shop had helped us choose the fruit and it was all good. There is a variety of banana that he advocated, as my favorite kind was unripe, and I can't say I care for it; I'll have to tell him, "The home didn't like it," or some such thing. Usually, if the female says the family did not like it, that excuse is accepted. Because, after all, we are supposed to go with what the family wants. Or something.

Navin is well and happy at Rose. That's a very good thing, affirmed a friend.

Scott, Naren, Navin and I got to skype today and that was fabulous. So much laughter and sharing. I don't think there is too much that each of us keeps from the other, and for this, I must be grateful. Even when the boys were getting into trouble at school, we knew what was going on - not that it warmed the cockles of our hearts. And now, we know of the older one's romantic interest, causing a friend of his to say in some surprise, "Oh, your parents are cool with it?" Yes, we are cool with it; Aishvarrya is a sweet young woman and Naren is lucky. Let us see whom the quiet and shy Navin will end up with. That said, about 80% of Navin's school friends were female, and to a person, wonderfully nice people. The boys had questions for Scott (on this and that) and I greatly appreciate the fact that they think their Dad is worthy; I think young men must always think that of their fathers.

I got to talk to my own father and that was nice. He stays busy, which is good. Makes missing my Mom bearable. And eases our concern.

"A blank page is God's way of showing you how hard it is to be God." - Unknown

Until next week (Unw) -

R

Report of 05 Feb 2012

Hello from my living room!

And here I can see my clothes drying on the balcony. I had to throw a bunch of food today - spoilt, to my great regret, and thus I had to waste it, another regret - and the dishes are drying in the sun as well. I have some kind of weird belief that the sun might nuke lingering fungus.

The B has been good. BALM organised a seminar by an eminent psychologist from Vellore; he spoke on "Surviving natural disasters like the tsunami." It was nice. One of our patients, Ms. T, was in the audience as well, and when we rapidly ran out of chairs, she stood to make hers available to someone. We did not want that - our patients are, indeed, our honored guests - and we urged her to sit and listen. She is one of a handful of our patients who speaks English, and if she could benefit from the seminar, why on earth not. The speaker called for volunteers at one point, and as I debated in the non-responsive silence whether to go on stage or not, I felt a pen poke me in the back: Ms. Vandana. So I toodled up on stage (I would do almost anything for her and Vaish), and participated in the exercise. I was wearing a sari, and it takes a bit of adjusting to negotiate stairs, etc., but I managed; it was my mother's sari, and a personal favorite - with black dots on a white background, dots patterning flowers on the border and big red dots in the center of the flowers. I love the black and white and red combination, and my mother had excellent taste in clothes, so I wear her saris with much nostalgia and joy. As a co-worker remarked on the rarity of my wearing a sari, I told her one must occasionally shock the populace. She laughed out loud and asked if my husband liked my wearing saris; I answered that my husband was pretty pleased with whatever I wore, engineer (and thus, non-fashion-maven) that he is. Sometimes, I tell Scott that he must talk about how blobby my gut is, etc., as some spouses do, and he is very non-committal in his replies.

We have had a string of deaths at the B due to pneumonia, and are on the quest for the pneumonia vaccine. Vaish has sent a long, philosophical reply to my question on sourcing the vaccine, and I am yet to read all of it. The health care workers are upset about some of their favorite patients passing away and there you have it - another ringing endorsement of the hcws' passion and commitment. We have debriefed some of them. One of the patients had HIV, and died peacefully. She was a tiny person, older, and did not speak any language we understood. However, I was always very happy that she was safe, and sheltered, and had 3 meals to eat, and clothes to wear, and medication to take. That she died surrounded by those who cared deeply for her, instead of alone and in pain and neglected on the streets, is a big, big blessing for me. She would cry on occasion, with none of us able to figure out why, but mostly, she toodled about her daily life and her routine, tended by our able staff.

I was in Bangalore yesterday, to participate in Rose-Hulman's recruitment initiative there. At first, I was not going to attend, but Jim Goecker, who had come, is a good guy and one of the first people I met at Rose. He had shown me around campus and answered all my questions, especially addressing the "We cannot afford this school" concerns. His daughter, Liesl, is working in Mumbai currently and she was there as well. She was a delight, and we gabbed away about many things. The event was not well-advertised, so attendance was very thin, and this bothered the wealthy parents who had put it together. There is a big dichotomy in India, with vast swathes of poor, and then several folks who can afford to send their children to Rose-Hulman. A taxi was placed at Jim's service, and he was not leaving until later, so the organisers asked me to get dropped at the airport; this was good and off I went. The taxi driver, Mr. P, has a disabled daughter and we spoke of her, and life, and the distinct possibility of getting her some help and training. I tell you, this is the joy of working in the NGO world: that we can hopefully connect those with desperate needs, with those grand hearts that can try to satisfy them.

In Bangalore, my sister-in-law, Susan, and her kids, Sudhir and Sanjana, took me out for lunch at a very nice restaurant that serves non-Indian food. I had steak and the meal was spectacular. We then walked to a famous ice cream shop, The Corner House, for dessert. The kids walked ahead, and Susan and I came behind, all gabbing away; it was a magnificent afternoon, full of the reassurance that Manu's family is well and happy. When he died, it was traumatic for all of us, and I am much relieved that his family is okay. Susan is very close to us, and the kids have cousins only on their Dad's side, so we see them a fair amount - a treat for me. There was a lot of eating and talking and laughing, and then Sudhir drove us to the venue of RH's event, the Oberoi, a ritzy hotel where he used to work. Several people there recognised him and I got extremely good treatment because of him.

Our neighbor had been ill with a respiratory infection, and I saw her and treated her. She wandered up 2 days later with some very expensive and rich sweets, to thank me. There was no need for that. The sweets have promptly gone to our friendly autorickshaw driver, Mr. E, who waited at the airport last night for me to get in. Naren and I had planned - when I booked the tix - for him to get me, but he's off covering an event in Vellore. The city is not safe at night for young women travelling alone - indeed, which city is? - and I had plotted to save myself from all manner of grievous harm. Mr. E to the rescue! So he got the tin of rasagollas for his family, and Naren and I saved our waistlines. This is a very nice part of my life: just as quickly as rich treats get to us, they go to those who would otherwise never taste them. Neelima's mother's gift of cookies is still being spoken of at the B.

I saw "Haywire," solely for the powerful cast and the pulse-increasing Mr. Fassbender. It was dreadful. Let's put it this way: I used to be a Mr. Fassbender fan.


Scott and I skype'd this morning and that was nice. Navin was to join, I think he forgot.

It's a good life, and a nice profession.

"Three out of four doctors recommend another doctor." - Graffito

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R