Report of 25 Nov '12

Good evening from Chennai!

Scott is on the bigger sofa (he is a foot taller :) ) reading a book on Lean that our friend, John Sparzo, gave him; Naren is out rehearsing; I am blogging.  We are invited to dinner, but I have an attack of pink eye (or "Madras eye" as it is called - conjunctivitis) and think I will infect all the attendees if I do go. 

The Banyan has been very busy.  We have a couple of enthusiastic volunteers who will not let issues drop off our attention spans and I greatly appreciate this.  An organisation such as ours needs such diligence.

One of our patients, Ms. S, is HIV+ and had been on Siddha medication.  On one of her most recent follow-ups, they found that the cells in her blood that are needed to fight infections (white blood cells) had decreased, and she has been started on Anti-Retroviral Treatment (ART).  She had to be admitted in the hospital while all this went on and now she is back, to my great delight.  She's a fine one, Ms. S - ostensibly from Mumbai, was found wandering around half-clad, and she is now with us, healing nicely.  She speaks excellent Tamil (not an easy language to learn, given her mother tongue is something else) and is always cheerful, with flowers in her hair and a genial greeting to me when I come in.  She works at the B, and does a good job.  She is extremely attractive - sensuous and sensual - and makes a pretty picture.  She likely has family elsewhere, but does not mope or speak of them, and has quite naturally adopted us as her new family.  As she was on the streets, perhaps we are an improvement over what befell her there.  Isn't it amazing how much the soul can endure and still smile.

Classes for the health care workers have resumed and last week, we spoke of dengue.  It was a fine session, with lots of interaction and questions.  These young women are truly a teacher's delight.

Scott and I saw "The life of Pi," and it was excellent.  Naren and his friend, Karan, had auditioned for it a few years ago and I was determined to not like the flick as neither young man was selected.  Suraj Sharma, the actor, has done a fine job, carrying the movie almost on his own; it is difficult to sustain a one-person flick ("Castaway," "127 hours") and he did it, with Ang Lee's capable help.  The movie was lovingly filmed and both Scott and I enjoyed it.

It is almost Christmas season and that means the plays and shows featuring Christmas music are here; usually, the performances benefit some noble cause and we merrily overpay and lap up the music.  Yesterday was one such play - "Stand by my side" - and it was excellent.  Needless to say, I bawled through some of it, and am always moved by Christmas music, especially "Oh, holy night." The tendency to treat Christmas as a giant buy-fest does not exist here, for which I am very grateful.

A wonderful thing happened earlier this week: we got to see my niece, Ahana.  We don't see her very much, for various reasons, and this time was a treat.  We met at McDonald's, had a meal, handed over some gifts, and listened to her talk and share; she was genial, fun, cordial, respectful and a complete treat.  We had a spectacular and memorable time, which I was thankful for.

I got to talk to my Dad briefly and he was very busy, so we'll catch up later.

Hope you have spectacular and memorable times of your own.

Unw -

R      

Report of 20 Nov '12

Hello from Chennai!

I've had a good few days and hope the same with you.

The Banyan has been fine and we are trying to improve our hygiene so that the rat-borne disease, leptospirosis, can be kept at bay.  The health care workers have been magnificent in understanding the vitality of cleanliness and the place has been sparkling.  I've had to curb food brought in from outside, as well as temporarily shut down our pettikadai (snack shop) and today, I heard about it from the resident who runs the shop.  She would like her salary, which can only be given if she works at the shop, and she was promised (not by me) that the shop would open today, so she was irate when she found out that it would not open - by my decree.  She narrated in articulate terms her ire, and raised her voice, and it was all good; well-thought-out fury.  I like it.  As I told senior personnel, to be senior means to take decisions that would be unpopular and this snack shop shutting is one of them.

Kovalam is busy.  Around 70 patients this week, to be seen in 7 or 8 hours.  So that amounts to about 6 minutes per patient and I have to fly along.  One of the patients is the grandmother of one of our colleagues, Mr. M, and I was delighted that she came to see me; I treated her aches and pains, and found that she had not eaten.  She raised her grandson after his father, her son, abandoned the family ("Please don't tell anyone," she implored, not wanting the shame) and the grandson adores her.  He would provide her meals, but she does not want to inconvenience anyone.  I'd darted across to the little shop across the road (both the owners - a couple - are my patients) and bought some fried peas as peanuts were unavailable; I gave some of it to this lady and she said, "To eat?"  I said, "Yes, please," and we shared a companionable moment.  After getting her meds, she came back in my room and said, "Shall I bring you some fish next time?"  I said, "Please don't spend a ton of money," and she said, "You can pay me back," which I will gladly do, as I love fish and shrimp. 

One of the patients said to me, "You treat those of us who have nothing."  I said, "You get ill, too, do you not, it's not just those with loaded wallets," and she smiled.

I am not genial with those who do not get blood tests as ordered, and I shouted at a couple of patients, stating very clearly that I would not see them next week if the tests were not done.  I *have* to know what state their diabetes is in, to adjust their meds or not, and I do not appreciate being ignorant of that info.  Doctors in India routinely shout at their patients; while I was horrified at first, I find that it effectively communicates the urgency of what I want.  And I do think patients can spend a little bit to get this information, while the rest of the treatment and all the meds are free.

Said colleague above, with the grandmother, has opened a surfing school and we went for the inauguration.  It was nice, and there is international collaboration, with some Australians having donated surfboards, etc.  Mr. M was profiled in the newspaper, in a nice article. 

Scott and I went to Coorg for a cousin's daughter's wedding and it was fun.  It is nice to hang with young people, and listen to them be oh-so-congenial.  There were events the night before, as well, with drinking and dancing, and I danced like a wild woman; truly, the music does course through my blood vessels.  We visited some relatives in Coorg, saw cousins' kids, etc.  We stopped in Mysore on our return and saw my mother's older sister, who has dementia; she used to be a hospital administrator who resigned in protest after a politican dipped into the hospital's poor fund.  She is single and was a fiery one in her time; seeing her is still a joy.  We also visited a cousin's special needs child and that was grand fun; I adore this young man and was happy to see that he was recovering nicely from an attack of tuberculosis.

Over the weekend, there was a medical conference run by an eminent hospital here; Sundaram Medical Foundation (SMF) treats our patients for free and run an excellent conference annually.  I love to attend, and am always greeted warmly and enthusiastically by the organisers, many of whom trained overseas.  There was a lot of learning involved and that was great, also.  We attended a concert by a singer from Madurai and the band did covers, which I love - my favorite kind of live music.  They were so good that at their encore, "I saw her standing there," I had to get up and dance.  Had to. 

Diwali, our festival of lights, was last week and we celebrated it quietly as we were leaving for Coorg that night.  We will Skype with our younger son - spending Thanksgiving holidays working at school as he needs the money - this weekend and might catch lunch with our older son, if his schedule permits.  We are fortunate in our opinionated (whom did they get that from?) sons and being able to see them and other family members is a blessing I will likely not take for granted.

To those of you who celebrate it, Happy Thanksgiving.  To the others, Happy Week.

Unw -

R   

Report of 11 Nov '12, or 11-11-12

Hello from sunny Chennai!

We've done 3 loads of laundry, including washing Scott's and Naren's new clothes for Diwali.  Mine were done months ago, i.e., I have a new outfit not worn.  Diwali is on Tuesday the 13th, and new clothes are a must.  Up early, hair washes, new clothes, down to light fireworks, up to eat and then catch up on sleep :). 

Work has been good, and has served to set right my cosmos.  Last week in Kovalam, 70 patients had signed up for the General Medicine service (mine).  3 left, so I guess I saw 67 that day.  The accepted pace of 15 minutes per patient had to flee and I had to zip through all the folks, documenting the pertinent findings only, not all as I usually do.  It was exhausting and good, and it seemed to make a difference to some, so I felt better at the end of it.  One of my patients makes a 3-hour journey to see us; she comes bringing her daughter to the psychiatry clinic (in the room adjacent to the one where I work) and stays on to get her aches and pains treated.  [The daughter is much better after being treated by our able psychiatrist, but the in-laws have refused to allow her back into their house as long as she is on medication - "She cannot take tablets and stay in this house."  I suppose due to the stigma of a mental illness.]  This past time, I told the mother we'd give her an injection of a pain med, and some tablets and an ointment, and she started crying.  As I asked why, she said some kind things about how I spoke to her, and how we were electing to treat the patients for free.  I told her I'd been blessed with a good husband and fine in-laws, as well as two sons who did not seem to want to throw me out of the house, and she could relate to the fact that good spouse and in-laws and children were indeed blessings.

At our other facility, Adaikalam, I went on surprise rounds one day and found the place sparkling.  I asked the health care workers (hcw's) if it was because it was a Tuesday and Vandana would likely do rounds that day; they said No, they liked keeping the place clean.  I nearly hugged them.  A friend had given us a box of halwa (a rich sweet laden with butter and sugar and nuts), and after cutting a small piece out for us, off went the box to the hcw's, along with my thanks.  These are fine young women, I tell you.  The hcw in charge of the sick room (our acute care ward) had been saddened by a patient's persistent request for a visit from her family members, and for them to bring fish curry; often, relatives do not come to see these ladies, it is very sad and we can do nothing about it.  My colleague made fish curry at home and brought it for this patient, and the patient has since stopped asking for the relatives.  The hcw's do not make pots of cash, but they use what little they have to make the patients happy - willingly.  It is wonderful to have such colleagues.

I like the president of the U.S.  I've said it before, along with happiness that the Health Care bill passed, and both opinions have brought down the wrath of Khans.  So be it.  "Do not gloat or despair" after the elections, wrote the friend of a friend and I think that's excellent advice; I've since heard vitriol from both sides of the political line.  Folks seem to freely talk of their political affiliations in the U.S.; it is very hush-hush in India. 

Scott and I saw "Argo," and it was excellent.  I did not think much of Mr. Affleck as an actor before, but he's made a fine film - well-researched, respectful and with really good dialogue.  We sat riveted through the flick; it showed all that is good in the U.S. - teamwork, diligence, cooperation, respect, a never-say-die attitude, humor.     

Naren joined us for a fun lunch at "Texas Fiesta" yesterday and we had fajitas and some American cuisine.  Yummy.  I had a vat of salad and was hungry shortly thereafter.  We Skyped with Navin yesterday and that was fun, also; he had just awakened and when I asked if he was okay, he said, "It's finals week.  Everyone looks like this."  It was hilarious.

My Dad transited through after his conference, en route to Madurai; Scott and I picked him and a colleague up and delivered them to their train.  It was nice to see my Dad; he had been honored at the conference with his umpteenth award and was feeling mighty good.

I hope you have your share of mighty good things.  Happy Diwali to all of you!

Unw -

R

Report of 4 Nov '12

Good evening from our living room!

The clothes on the balcony are dry, I have been eating up a storm and must prepare for my class tomorrow.

My house is a mess.  There is stuff everywhere.  I despise clutter; if there is not enough space for things, I think some things need to go.  An immaculate house is not my goal, but a clean one, with stuff in its place, would be dandy.  I loved our teeny, 1-bedroom apartment in Indy; I had place for all my things and we did not have a whole lot of things.  This last part was my favorite.

I have been in a bad mood.  Living in an affluent country for months, and seeing what is possible if the Government cares for its people, leaves me a little bereft these days - in a country where the roads get wiped out after rains and the rank inequality of the poor not getting the food they need sets in daily.  I think this is borderline depression: I am no longer inclined to do something about it, but want to retreat to a hole and ruminate.  But, work must go on and we must do our part for those who have been left behind.  I texted Scott and Naren rabidly earlier this week, after I drove to work on cyclone-battered roads, and both men replied with the grander purposes of our existence.  That helped. 

As did Ms. E's smile when I pulled up.  The roads were horrible and I was fighting for space often in the only salvageable 2-foot wide portion of the road; as I reached, mentally, spiritually and physically exhausted, out bounded Ms. E.  She was supervising clearing the trash, as the resident clearing it might run off, and beamed at me.  Rachel McAdams's smile is nothing compared to Ms. E's, and she rewards me with this smile every morning that I see her, though I have done little to deserve it.  As already mentioned, when she was in the eighth grade, Ms. E was sold by her brother to transgenders (men who dress up as women and are usually castrated, preferring to live life as women) who then sold her into the sex trade.  I think of the many emotions that must have crossed a young 12- or 13-year-old girl's psyche as she morphed into adulthood - betrayal, horror, sadness, pain, resentment, torment - and think to myself that if she can smile, s***, so can I.

The patients have been good and mostly following what I tell them.  A patient showed up last week, claiming that she'd lost all her meds and I got a phone call that she wanted a replacement.  As one of these meds is a giant bottle of an iron supplement, and the lady's house was likely too small to lose meds in (no offence intended), I did not for one minute believe the story and refused the replacement.  I told our nurse to get the social worker to quiz this lady and have no idea what came of it.  (She might have given the meds away or sold them.)  Giving anything for free is fraught with such dangers, but evidently many studies in public health have stated that when a family's fiscal health suffers, medicines are the first casualty. 

A cyclone hit last week and we stayed home.  The gale-force winds wreaked havoc, and were pretty impressive to watch.  Staying home was nice and simple - eat, read, try to watch a movie between power cuts.  Naren played the guitar later in the evening and sang; I like his rendition of "Zombie" and joined in.  I love singing and dancing with my sons.  The other one, Navin, is bashful, but will dance if I request; there is a somewhat grainy video of us on YouTube. 

Scott and I got to see a Tamil movie called "Pizza," which we loved.  It was a thriller, and very well done.  We also saw "Cloud Atlas" and could not figure it out - 164 minutes of "What the hey?"  Today we saw "Skyfall" and I loved it; Javier Bardem made a cool villain.  We also got together with some friends for lunch at their house, and all the affection helped draw me out of the black mood I've been in.  Your words of wisdom would help, too; feel free to send them on. 

My father transited through Chennai and stayed overnight with us.  That was grand fun.  As I got up at 4 AM (fairly de rigeur) and made his coffee and then drove him to the airport, his profuse gratitude was pretty humbling.  It was just a bed and coffee and kesari (sweetened cream of wheat - his favorite), made for a devoted and learned parent, and it was nice to share those moments. 

Hope all of you have fine moments of your own with your families.  I know I am always grateful that I can see mine.

Unw -

R