Report of 27 Jan '13

Good morning!

It is pre-breakfast and my stomach is growling.  It is a cool 75-plus degrees and the morning is pleasant.

Regular classes resumed for the health care workers and this week, we spoke of intimacy, the menstrual cycle, pregnancy and sexually transmitted diseases.  We sat in a circle on the floor, I pulled out my Netter's Atlas of Human Anatomy - saved from med school days, thankfully - and we spoke, and spoke.  The class easily lasted an hour, and there were also discussions of birth control.  I said that our culture did not really endorse pre-marital sex but that we need not get holier-than-thou, that some information would enable non-fatal decisions.

I really, really like teaching the hcw's.  They are bright, and interested, and curious.  Many, many questions come up and I field as many of them as I know, stating I'd get the answer to those that I don't know.  The students from Texas had sent feedback and praised the staff, so I mentioned that and shared some candy in celebration; the candy cost me Rs. 50 (about $1) and is a phenomenal mood-elevator.  I remember hearing from St. Vincent hospital's Human Resources department that the value of a monetary increase lasts 2 weeks and intangibles last a lot longer. 

Our patient with the bone in her back sticking into her throat has backed off eating.  She gestures to her throat, that it hurts.  So, we have sent her for another x-ray and then, if we must consider surgery, we will do it.  This patient's family has likely forgotten her - she is mentally ill and a trifle mentally challenged - and we will not.  This is the pure joy of the B, that all are important. 

Kovalam has been good.  One of our patients is a young woman who was working when mental illness hit.  At our initial meeting, I had asked how far she had studied; she is a college graduate and holds a B.Com (Bachelor of Commerce) degree, like me.  I was impressed by her achievement and said so, smiling at her; she smiled back and it was a nice moment - a sharing of happiness, a recognition of another person, a feeling of achievement.  Her mental illness is under control, and I told her mother that perhaps she could return to work soon; her mother said, "It is enough for me if she is healthy, she does not have to work," and I recognised the concern of mothers everywhere for their young - for them to be healthy, and happy, and safe.

This pair and I took the same bus once to Kovalam, and the mother kindly offered to buy my bus ticket.  I demurred, stating that the purchase could be made when the daughter returned to work.  That was before the conversation where the mother stated that the daughter did not have to work, and was a fine exchange, nonetheless.

Naren and I drove to Madurai on Thursday, a day earlier than anticipated.  (We have a new car with a CD player, and joyously played music all the way there, and back; thankfully, Naren and I have similar musical tastes, so we played Santana and Led Zeppelin and George Harrison, and then some 80's music.  It was a fun trip.)  My Dad was at a meeting, and laughed out loud when he returned and saw us.  That day, we got the news that his colleague and friend had died, and went to the funeral the next day.  Dr. Edwin was a fine pediatrician, and my sister's teacher; she held him in very high esteem.  His son, Tony, is a friend of ours, and Tony and I talked, of his father and all his achievements, how glad Tony was to be able to spend some time with him without professional encumbrances getting in the way.  I feel the same about spending time with my mother. 

On the 26th, my father and I went to the cemetery.  I washed off Manu's tombstone and we placed a garland on it.  After that, I prayed there while my father likely said a silent prayer.  We did not say much to each other, as we would have bawled, but I remembered my handsome older brother, who loved my husband and adored my sons.  He would have totally enjoyed watching all these young people grow, and express opinions, and share love. 

Scott is back from his travels, it is good to have him back.  We Skyped with Navin today and that was nice. 

I hope you have similar joys.

Unw -

R   

Report of 19 Jan '13

Good afternoon from Chennai!

Sun shining, clothes drying - you know the drill.

This week was full of holidays for Pongal, our harvest festival.  This festival is often a bigger deal than Diwali, the festival of lights.  Folks buy new clothes, and celebrate by cooking and eating a dish called pongal - with rice and butter and brown sugar, raisins and cashews.  We do not usually make it in our house and sometimes get an offering from neighbors.

This was my week to work from home, as several patients would not have come to Kovalam, and several Adaikalam health care workers (hcw's) - whom I teach - would have gone home for the holiday.  It was quite refreshing to work from here, read medical literature, answer queries, grope for funds - standard fare.  In between, I fielded calls from work, many from Kovalam.  One of the patients there ostensibly perenially complains that there is something wrong with her; one day, it was to say she had fever, and her temperature was checked and found normal.  She took Tylenol/Paracetamol, and the young nurse called in a bit of a fit - that the temp was normal and the patient was self-medicating.  I told her to let the patient take a Tylenol or 2 (relatively harmless, provided there were no liver issues and I knew of none in this patient) and I would deal with this issue when I got to work next.  This patient has elected to stay at the Banyan as she does not like the person her offspring has married - or some such thing - and trying to accommodate her desires (as with everyone's) involves some give-and-take. 

Due to several factors such as other meetings and holidays, the health care workers and I have not had classes together for a couple of weeks.  The Texans taught a class and it was excellent.  I like it when visitors teach; the hcw's soak it up, full of the enthusiasm and zeal that poverty has not squelched, and benefit (thus, so do our patients).  I think next week we'll talk about intimacy issues; the days of no premarital sex are likely gone.  They probably never existed in toto, anyway.

Rapes are being reported regularly now, and it is distressing.  I rather like the notion of teaching young men not to rape, and hope the Banyan or other NGO will step into this effort.   

Naren was home quite a bit, and had managed to procure several Oscar-nominated movies from friends.  So, we watched a bunch and that was fun.  The whole magnum opus issue with the awards - "Les Miserables," "Lincoln" getting nominated - did not quite jell with me, and I must say I quite enjoyed "Argo" (seen previously) and "Django unchained" and "Silver linings playbook."  Jennifer Lawrence has consistently impressed me, from "Winter's Bone."  I simply could not get into yet another Sally Field, or Anne Hathaway - impressive though they were, especially the latter - as I was in the mood for some flash and dash, and not bedsores with lengthy movies.  Also, folks bursting into song are available aplenty in Indian flicks.  Why Mr. Hardy was not nominated for "Lawless" is a tad incomprehensible; perhaps the movie was ill-timed, or too violent.

Yesterday, a very elegant new hotel here invited some corporate leaders for a meal.  My friend Pushkala and her husband had been invited, but he did not want to go.  She clarified with the hosts, and then invited me along.  The meal was spectacular and the evening nice.  I was actually in the mood to schmooze and met some fun people. 

Scott is in the U.S. and Navin is busy this weekend with his fraternity, thus we have not Skyped.  Naren is busy with music lessons.  I got to talk to my Dad and that was fun; he is travelling to inaugurate some Plastic Surgery thing or the other, and staying busy - which is good. 

Unw -

R

Report of 13 Jan '13

Good morning!

It is cool and sunny - perfect.  Our clothes are drying on the balcony, one young man is asleep, one is in college, a husband is travelling as I write.  The power will go in 20 minutes and I am scrambling to finish.

Kovalam has been good.  The usual frenetic clinic.  The person who was told to come to the Government Hospital (GH) by the cardiologists had a cardiac cath done, where the doctors look to see if there is any block in the arteries providing blood to the heart; there was no block in this patient and thus, no need for surgery.  He returned a happy man.  I had told one of the other patients, a very poor person who kept coming with complaints of itching, that he had to be seen by a specialist; after not going for weeks, he finally went - halleluia.  He returned and said that the specialist told him he must get the meds at the Banyan (where we provide them for free) - likely an outright lie.  We stock the meds we can, and the patients get seen by other docs and then come to the B to try and fill the outside prescriptions, which we do not permit.

The sense of entitlement of the poor here is just as much as elsewhere.  Free meds, free care, free concern are not enough - some have even asked for bus fare to go to the specialist.  As I have not received my salary for 2 months, it becomes very easy for me to handle such enquiries.  I am also perilously near menopause, so am constantly irritable.  Again, this makes it easy for me to answer such questions - "The answer is No, and if you don't like it, feel free to find a similar organisation elsewhere and frequent it." 

We lost another patient last week in Adaikalam.  The official diagnosis was TB (tuberculosis), but on looking over the file, I saw that the patient had winced when the med students were doing a breast exam.  I think she had breast cancer, and was slowly wilting.  There is absolutely no way for me to get a post-mortem (the request has to be accompanied by a police report, casting blame either on the hospital or ourselves, so we don't pursue it), so have to guess at the cause of death.  I was very pleased at the Texas students' thorough exam.  My nurse colleague, Adhi, and I talked of Ms. R's death, looking at the file and almost bawling; a wife, mother and good person had died, her family likely had no clue where she was and that she had died, we mourned her more than anyone else did.  It was a tough loss.  As Adhi and I said, we are aging, our hair is grey, I now wear glasses and we deal with the loss of one among those who are with us and grow old with us.  I touched Ms. R's photo in her file, almost willing her back to life.  She had married, and likely had kids, and had loved them.  Mental illness hit, forcing her to a place far away (her name ended with "Kaur" - a Sikh name); we treated her and fed and clothed her, and without fail, loved her until she died.  Even after. 

This is the joy of working at the B.  That every patient is important.  This was revealed even more at the "Death Audit," where a team investigates issues surrounding the death and if it can be avoided in subsequent patients, seeking to learn valuable lessons.  I sat in awe at the discussion generated by the social workers and psychologists and nurses and Vandana, who is unfailingly a joy to be around. 

A team appointed by one of our funders to see about assessing the funders' involvement visited us and interacted with us.  They were grand fun and it did not seem like any sort of scrutiny.  Again, the insight of these folks was enriching and I enjoyed the meetings.

Scott and I hung out some, through my bout of food poisoning and that was nice; Scott is big salve.  Naren, he and I played Scrabble yesterday, bringing back great memories of Friday nights when Game Night ruled at the Weisses'.  Navin and we Skyped last night and that was also fun.  My friend, Pushkala, had me over for lunch yesterday to meet up with a common friend, Medha, who now works with the Gates Foundation.  Medha is a visionary and bright lady who has worked to prevent trafficking of women in North India; most people work in rehab of those rescued from trafficking.  It was a splendid time talking with Pushkala, Medha and Pushkala's mother, whom I love dearly.  It is nice to hang out with like-minded people. 

Hope you have such joys, also!

Unw -

R

Report of 5 Jan 2013

Happy New Year!

It will take me a bit to write "2013" - I have already written 2012 a couple of times.

The son is shining brightly, a certain husband is sitting next to me in shorts and his new short-sleeved shirt (a gift from us for Christmas), one son is travelling back to college and the other is out and about doing theatre stuff.

Last Sunday, we went out for an expensive lunch with both boys.  The food at upscale restaurants is delicious, and we pay for it, too.  But we had a good time, and talked.  The boys do not hold back their opinions at all - any clue where they get this?  We returned home and all hung out here.  I went to work on Monday, it was busy.  An older Muslim gentleman brought 6 students from his Madrassa (Islamic school); 4 had complaints of the testicle, which is not my area of expertise at all, and one had a ear problem, one was too young to be seen by me.  I referred the 5 to the Government hospital to be seen by a specialist.  These young men had my sympathy, I tell you - likely separated from their families due to poverty, like many, many others, and having to study in a strange state.  In other countries, Madrassas take the form of indoctrination into the violent world of Islam, but not here.

Many patients balk at going to the Government hospital.  If they get there, many are sent on a wild goose chase to get to the specialist of their choice and hate the denigration they experience.  This is not unique to Indian patients: there was a patient at our residency clinic in Indiana who stated that the specialist's office had yelled out to him in the crowded waiting room, "Mr. X, are you on Medicaid?"  (Medicaid is a U.S. Government health insurance plan for the poor.)  He had not liked it at all, wept on saying it and liked coming to the residency clinic, busy though it was.

At last weekend's Family Day, we had sat together with the students and Stray Factory for lunch, and a merry time was had by all.  Our deaf-mute patient, Ms. L, had already kissed one of the students and she then proceeded to plant a kiss on Navin, embarrassing him thoroughly.  She had been on stage prior to that, dancing when Naren and I were dancing, trying to follow the steps though she could not hear the music.  (There were several other residents and others up on stage with us, too, quite throwing off our concentration but adding to the overall merriment.)  I heard yesterday that Ms. L had died, drinking wood preservative and not surviving.  I told Navin he would go back to school, overseas and far away, with her blessings, as he had been kissed by an angel.  In the midst of our sadness, I am soothed that Ms. L had been very happy the previous week - dancing, getting attention, kissing men and women. 

A gruesome rape happened in Delhi about 3 weeks ago.  A young woman was travelling on a bus with her male friend at about 9.30 PM; 6 others in the bus raped and brutalized the young lady and then threw both out of the bus.  The woman was a physical therapy student from a poor family (her father had sold land to finance her education) and 23 years old; she spoke of wanting to bring the accused to justice and of wanting to live.  She fought for life bravely, and was transferred to a Singapore hospital, likely for non-medical reasons.  She died last Sunday, her persona and her situation have resonated with many, and her demise has been mourned nationwide, with calls for increased safety for women.  Among the debates: why should women eternally be told to be safe and cautious, why can men not be taught to not rape women?  Yesterday, our sons and we had a discussion on this and the death penalty for rape, and as always, I was hushed with awe at these boys' extremely insightful arguments. 

We ushered in the New Year with friends and then the boys got together with their own friends.  We saw some dearly beloved family friends on New Year's Day, getting their blessings, and then spent a couple of days in Pondicherry, a lovely former French colony about 100 miles from Chennai.  It was a nice time, eating out, playing games, enjoying family time.  We returned on the 3rd and the boys promptly fled to their friends, while Scott and I - did laundry :).  Navin left yesterday and the house is quiet.  The financial penalty to change Navin's ticket and get him home was well worth every cent - we got to experience his gentleness and sense of humor and sensitivity.  Naren's boisterous sense of humor and chattiness complemented all this nicely, and a memorable time was had.  We took some family pictures yesterday to commemorate this occasion.  We went out for lunch to a restaurant co-owned by Chef Willi (who'd so kindly and graciously provided the biryani for the Banyan), and as it turned out when we asked for the bill, Willi gave us the sumptuous lunch on the house.  Wow - that was super nice of him and was a great start to the year!

We heard from the students after they left the Banyan, and that was very nice.  They were a fun, exuberant, enthusiastic and curious bunch, and enriched the lives of many at the B. 

Happy New Year to you and yours!

Unw -

R