FINAL INDIA ENTRY (Part 1)!

Ok. I know I said I would write later…I am, just quite a lot later! So much has happened since I last wrote- I have a feeling this is going to be a long entry! I am currently…a certain number of feet up in the air…not sure how many exactly. I am on my flight from Bangalore to Kuala Lumpur. It is quite shameful really that I haven’t written for over a week, but don’t worry I have been making notes so I won’t forget anything.

The last time I wrote, it was early morning on a Wednesday. That day we went on a Mobile Clinic Visit. The hospital has a mobile clinic, which is essentially a massive box on wheels!! The picture below from the outside doesn’t do a good job of portraying what it is really like so I will do my best to explain!

There are 2 benches, one on either side for the patients to sit, 2 pull out tables (one for a clinic table and one for a pharmacy table), a blood pressure monitor and a big trunk full of the most commonly needed medications (e.g. Gamexin- to treat Scabies! And Ciprofloxacin- to treat a whole variety of infections). There is no such thing as patient confidentiality and all the patients sit in the van as each is seen, and if anyone needs to be examined, there is lots of shuffling and standing and putting of children on laps until there is space for them to lie on the bench. It sounds basic, but it was actually very cool. Things just appeared, as they were needed! Old sari material had been used to fashion a sling which was suspended from a hanging scale which could be hung from a hook on the roof of the van to weigh children as needed, and there was a tank of water in the corner attached to a tap over a small sink so that hands could be washed. I was really impressed! The mobile van is really an amazing part of the Adivasi hospital’s care – some of the tribal villages are really far away and really deep in the jungle so it is an absolute mission for them to travel to Gudalur Hospital. With the mobile van – the care can be taken to them! The van goes to each village (as nearby as possible) once a month. The Adivasi can then come to the van with any problems that they have, for antenatal checks or to collect medications. So, on Wednesday we got to see the whole process in action. What we did not realise however, is that even though the villages are informed by a health animator (like Parsu J) of the mobile clinic date- everyone still hikes from house to house and village to village in the mud when we get there to make sure that there aren’t any Adivasi who are too sick to come to the van or if they are just reluctant to seek care. In this time the patients have time to make their way to the mobile clinic so that when the Doctor, health animator, and (sometimes) nurse get back, all the patients are ready waiting. The hiking part would not have been a problem- it’s a bit muddy and slippy – but the scenery is spectacular and its so interesting to see how the Adivasi live. I even got to play the instrument that they make out of wood to scare away elephants! HOWEVER. We were not prepared, we didn’t realise hiking would be part of the days agenda. I was the only one with appropriate footwear, so whilst the others chilled in the mobile van I set off to inform the villagers of its arrival. When we got back, many patients had arrived and we set to work. lack of translator in the van proved to be a problem! At the hospital, one of the nurses, Suda – who I absolutely love, she is so sweet- and who also speaks English perfectly- translates for us when we are alone, but she hadn’t come on the visit! Even though the Doctor spoke English he was too busy with the long queue of patients to spend much time translating for us so I mainly checked blood pressures and did an antenatal check. It was still really interesting to see how it worked even though I didn’t get to do much. Also – I met the sweetest kid who I just wanted to hug he was so cute- but I didn’t as he had horrific scabies all over. I asked him if I could take a picture of him with his hands outstretched so that his scabies burrows and scratches could be seen. He agreed and was so delighted at seeing the photo he wanted another- and another, and for each one he put his arms outstretched even though I tried to tell him he didn’t need to!

After lunch- we took the mobile clinic to another set of villages, a bit further away, and again set off to call patients to the clinic. Literally. It started to pour with rain and Parsu decided instead of hiking to the village across a valley – we would call across really loudly to check all was well and inform them that the van had arrived!

On the walk back to the mobile van, the rain hardened and Dr Gopal and Parsu sent Mona, (who had decided to come despite her poor choice of footwear) and myself a quicker route back whilst they took a longer route with a broader path so that they could share an umbrella!

This was a mistake. We should have gone the long way. Instead we ended up getting extremely confused about the turn off from the path and convinced ourselves that we were lost. In the rain. As if this wasn’t bad enough, disaster struck. I suddenly felt a sharp pain above my right ankle. I rolled up my trousers to reveal A LEECH.

Now I’m not sure if I have mentioned the leeches before…first of all let me say that these are no ordinary leeches. They aren’t the big fat slow ones that I have seen in England. They are quite small and super speedy and move in the weirdest way – with a movement similar to the breakdance move where they get down on their chest and wiggle along the floor….anyway- its hard to explain but it is SERIOUSLY freaky. They love muddy paths and so there were quite a few where we were waiting for someone or something to latch onto with one end of their body. Then they inject an anticoagulant of some sort and then suck loads of blood. Initially they are very slim beings, but by the end they are obese. Unless you get them off quickly. I had previously not been afraid of these leeches (although obviously it was preferable to keep them as far away from my skin as possible) but I figured I would just pull them off, no bother. HOWEVER, I had been scared that very day by Dr Gopal as apparently if you pull them off and their sucker stays in- you can develop a chronic itch at the site lasting YEARS! In that moment when I looked down and saw the leech dangling ominously from my leg – all I could think about was suffering from a terrible itch for years to come. And I was terrified! I decided to run in the direction I thought the van was in but then slowed to a powerwalk in the fear that somehow the leech would fall off leaving his sucker lodged in my skin. Thankfully I got there and we tried the theory we had heard that if you spray a leech with DEET it lets go. Thankfully we proved the theory. I love DEET.

The leech saga exhausted me completely and I dozed as much as possible on the return journey to Gudalur (which wasn’t much as the roads are so bumpy). You need to concentrate a lot to stay sitting on the benches in the back, which is where we were sat. There was no time for rest either as I had plans to purchase my train ticket to Pondicherry as soon as we arrived back to Gudalur, which I was very excited about. I have always wanted to go to Pondy as I love all things French and French influenced and had read a lot about it. I had planned to travel there for a weekend whilst working at the hospital but it was really quite far, so I figured out that the best way to do it would be to go following our time in Gudalur, before spending a week in Mysore, a week that had been organised for us by the hospital. However, I was unable to convince either Mona, Duana or Juli that a 29 hour round trip involving 2 night trains and multiple buses was a good idea. So I decided that I would do it alone. Now, I have travelled alone before, but only in Europe, never anywhere as foreign as India, but I decided I could handle it and that it would be an interesting experience! So it was with a positive attitude and a spring in my step (partly because my leg wouldn’t stop bleeding!) that I headed to the travel agents to book my night trains! Although the system was down, the agent assured me she would book them ready for me to pick up the next day, Thursday. Delighted and nervous at the prospect of a night train alone I took a rickshaw to the Doctors quarters to meet the girls so we could walk together to Dr Shyla and Dr Nandukumar’s house for our last cookery class! It was wonderful! They say a picture tells a thousand words so:

On Thursday morning I woke up nervous and excited, and packed up all my things ready for my trip to Pondicherry! I had booked the night train for that evening from Mysore, and was going to go to town early afternoon to pick up my tickets and take a bus to Mysore, about 2 hours away. I had arranged with the girls to bring my big rucksack to Mysore as they had a car booked straight from the hospital to our hotel, and I was going to meet them there on Monday morning. After breakfast, we went to the hospital for my last outpatients clinic. I was very sad! I said all my goodbyes to my nurse friends- especially Suda and Shiela and to all the Doctors who were absolutely wonderful the four weeks we were in Gudalur. I am embarrassed to say I bawled my eyes out! After all the fond farewells (it felt so weird and sad to say goodbye to Duana and Mona and Juli- we had spent all our time together in the preceding weeks and had grown quite attached to each other!) I set off into town to pick up my tickets.

However, on arrival at the travel agents, I found out there was a problem- my return night train had not been confirmed. There was a chance I might end up stuck in Chennai. Disaster. I did not know what to do. I really, really didn’t want to get stuck in a far away city for an indefinite period of time. Alone. The train booking system in India is REALLY, REALLY complicated, and I just couldn’t figure out the best thing to do. I was number 17 on the waiting list for class 3 AC and I had no idea what the chances were of 17 people cancelling. After much umming and ahhing I chickened out and decided not to go. I just couldn’t decide whether going was a really stupid idea when my return was uncertain. So feeling pretty blue- and even bluer when I realised I was going to have to see everyone again after already having said such heartfelt goodbyes, I plodded into town, not sure what to do! I called Mona and her Juli and Duana came into town to meet me and we went for tea and cakes at Lulu Bakes. I had two cakes. And two teas. I was depressed. There was nothing I could do and so we headed back to the quarters where I didn’t think I would be returning- at least definitely not that soon! It was a weird feeling! But then, at dinner that night, all the Indians convinced me that I could go the following morning and either get ‘quota train tickets’ (a certain number that are released on the day) or take a bus. So I decided I would head to Mysore the following morning and see if I could get myself to Pondicherry!

The next day at the break of dawn (well, 7:30am) I left and caught a bus to Mysore. I managed to book a quota train ticket to Chennai where I would then be able to catch a bus to Pondicherry. However, the train ticket purchasing system is so weird. I had to queue, to get a form, to queue again, to find out I could only buy a ticket between 1 and 2 pm! So I returned at 1pm on the dot to buy a ticket. But I still couldn’t purchase a return ticket! To purchase that I had to go to a separate office in a different building, 5 minutes away. There I had to take a ticket and wait for my number to be called. 45 minutes later, I was still waiting and about to miss my outgoing train! I had to abandon the waiting room to make a dash for it. I made it, but I was still without a return ticket! The train to Chennai made a stop at Bangalore- 2 hours away and I am ashamed to say, I chickened out yet again and got off in Bangalore!

So there I was, in Bangalore, no idea what I was doing! The girls were due to arrive in Mysore the next day, so the choice was between going back to Mysore and staying there a night till they arrived or spending one night in Bangalore and heading back to Mysore the next day. I couldn’t face getting straight onto a bus and I also needed to get my camera fixed as it wasn’t working well. A big worm like shadow kept appearing in the middle of all my photos and ruining them. It was really annoying. So I found a place to stay- the second place I tried, the first one was really dodgy, put my camera in to get fixed and then did a spot of shopping. Bangalore is a good shopping city- with lots of little handicraft shops, and big emporiums, as well as Fab India- a fantastic shop that sells really nice Indian clothes, bags and accessories. I spent a bit too much money there! I headed back to Mysore the next day at around lunchtime although with a more broken camera than I came with. They were not able to de-worm the camera and it now no longer focuses. Disaster.

I made it back to Mysore, although I was SO sick on the coach. I don’t know whether it was something I ate – I think it may have been the milk I had the morning I left Gudalur- apparently its only partly pasteurised and you have to boil it before drinking. I did not know this. Anyway, whatever the reason, I ended up back in Mysore feeling significantly worse for wear and desperate to get to the Green Hotel where I knew my pals were. But this was not to be an easy task. At all. There is a pre-paid rickshaw stand at the bus station in Mysore, and you have to use it as all the drivers just serve the rickshaw stand. Basically, you tell the guy where you want to go and he calculates how much it should cost depending on the distance and prints out a little slip with the destination and the price. For this you pay 1 rupee. The amount you pay the driver. The whole point is that a fair price is paid. However, my allocated driver had no idea where this hotel was and drove me to a random location and said we were there. We were most definitely not there so I refused to get out as I had no idea where we were! He then insisted I pay him more than double the amount on my slip. I again refused. So he drove me all the way back to the pre-paid auto stand. Extremely frustrated and still feeling awful, I jumped out the rickshaw to confront the dude behind the desk. Turns out, he had put the wrong address. So he printed me a new slip, again the wrong address when I checked it against the address I had. By this time a big queue was starting to build up and my rickshaw driver had parked his rickshaw in the middle of the street to come over and join me at the window. He was very rude to me and I was started to get worried I was never going to get to the hotel! My problems had only just begun. First all the rickshaw drivers waiting for passengers started to leave their rickshaws and come over to the window of the prepaid auto stand to express their anger that a huge queue had built up and they weren’t getting any passengers. So the dude behind the desk refused to help me and refunded my 1 rupee. Then, a huge cry and my rickshaw driver was running like the wind down the street after his rickshaw. It had just been stolen. OMG. I felt terrible even though I know it wasn’t my fault. But the rickshaw drivers all seemed to think it was and they got even more angry- all of them shouting at once and getting pretty worked up. I had no idea what to do. Thankfully – an Indian man who had heard my predicament called up the Green Hotel, got precise directions and managed to get me a relatively friendly driver to take me there. My hero. I was so delighted to arrive at the hotel after my ordeal I gave him a fat tip. I still felt pretty bad about the first rickshaw driver though. Even though he was really mean. I hope he got his rickshaw back.

So at this point in what is shaping up to be the longest blog entry EVER, I have to stop for a while as the laptop battery is quickly dying and there is no means to charge it on the plane! We are up to Saturday night, last week and there is still much to tell! I was sick all of Saturday night and Sunday morning but by Sunday afternoon I was ready to explore all that Mysore had to offer. And I was very happy to be reunited with my travelling buds!

Early Morning Blogging

It is Wednesday morning, 6:15am. I share a little room with Duana and she is such an early bird, so often I find I wake up when she does. Whenever I wake up around this time I go put water on to boil first thing. That way I can have the maximum amount of hot water for my bucket shower! Sometimes I get back into bed for 15 minutes, but normally I either catch up on some blog writing or read my book. I am reading a really, really good book which I would thoroughly recommend. It’s called Shantaram, by Mr. Gregory Roberts and is about his crazy life escaping from Jail in Australia and coming to live in India. It’s a War and Peace-level fat book, but I like that as its not finishing too quickly. I am really glad that I decided to read it while I am here as it is so funny to read about his observations and compare them to my own- for example with regard to the Indian head nod or ‘wiggle’ which I have been practicing. If you know a genuine Indian or have been to India or have read Shantaram, you will know what I am talking about! Actually, I first learnt about it when I did my paediatrics attachment at Eastbourne DGH as the doctors in the department were mostly 1^st generation Indian and they did the headwiggle often and very well. It was confusing at first…I was never sure whether it meant yes, no, maybe or something else entirely, but I believe I have come to master the translation of the Indian head nod!

Yesterday was a good day. We had lots of teaching on cases and on seizures and we spent some time clerking a patient with cardiovascular signs. She was a tribal lady and was so patient with us. It was the first time I have really felt like I could take my time and properly listen to the heart sounds and it was a great learning experience for me as she had two classic murmurs (although I only managed to correctly identify one of them!) Afterward, Dr Abu (remember, the one with the amazing laugh?!) gave us some teaching on murmurs and it was super. It all made so much sense when he talked it through, and I hope it still makes sense back in England when I am frantically auscultating a relatively unwilling patient on a busy ward! I took a photo of Dr. Abu because I actually love him. As a doctor/teacher/pal that is! I don’t want him to get the wrong idea if he reads this! We met his wife at the party last night and she was so sweet. They are only recently married and the medical students who were here at the time got to attend the wedding. I’m so jealous. I really, really want to go to an Indian wedding! Preferably with an elephant!

I have made two new friends, Arti and Upant who are postgraduate medical administration and management students from Mumbai and who are posted here at the hospital for the next two months. They are so nice and friendly and we get on really well. They are also both soon to be engaged and I have been informally invited to both their weddings! (I am hoping to have a formal invite before I leave!) Upant is really ‘tech savvy’ (I love how they say that) and has helped us download films off the internet. We watched ‘A Little Princess’ last night and it was so amazing. Mona and I have really been wanting to watch it the last few weeks. I don’t know if you have seen it…if you haven’t you most definitely should as it is a beautiful film…but it is partly sent in India and tells the story of Rama intermingled with the story about a young girl brought up in India but who then has to go to a strict boarding school in America. It is excellent!!! I watched it so many times when I was little. It took Mona, Upant and I several hours of back and forth to the computer room in the office in order to download it, and we then needed to download some special player (not sure what, I’m not tech savvy(!)) but it worked out in the end and me, Mona, Duana, Julie, Alice, Alan, Arti and Upant sat down and watched it yesterday. Almost everyone cried, obviously, even Alan!

Anyway, back to the party! I think early morning writing allows me to stray off topic and get carried away as I have lots of time on my hands! But Duana has just informed me that my water is boiling so I need to have my shower soon! The party was really good. It was nice to hang out with everyone and my dip went down really well! Dessert was also terrific. Main course was a little bit of a disaster as Duana didn’t know how to cook the instant noodles to go with the stir-fry and they are the only kind of noodles you can get in Gudalur! But it was still tasty :)

I have to go and shower now, and also put some washing on so that it has enough time to dry before we leave Gudalur- you have to allow a few days at least, I think I am cutting it a bit fine! I just can’t believe how fast time has passed and that is our LAST WEEK in Gudalur :( I know people say that, but really, it feels like we have been here a week or two…not four! 

Must go- water is boiling over!

Will write again later!

Weekend in Ooty

Monday 22^nd August

The internet is working (yay!) so I thought I would take advantage of it, but unfortunately I cannot write for too long as we are cooking dinner for 23 people this evening! Its Monday and we spent a pleasant, but cold weekend in Ooty which is about an hour and a half from Gudalur, UP the mountains…so it was cold!! Ooty was fine…its famous India-wide for its homemade chocolate which is good…not nearly as good as what we can get in England – but much better than the fake dairy milk (in the exact dairy milk packaging, but doesn’t taste like dairy milk) that you can buy in Gudalur. So we profited from that. We also went out for dinner to a fancy hotel and I ate steak. It satisfied my meat craving so I was happy! It was the first meat that I have had since coming to India and it was oh so good J

On Sunday, we took the ‘minature train’ from Ooty to a town about an hour away called Coonoor, just for the amazing views over the mountains, which we had read about.

Will post photos later - internet too slow!

Mona and I also had a great time hanging out the windows, which you can’t do on trains in England!

Our whole carriage consisted of us and a massive group of Indian tourists who made their fondness of tunnels very clear by shouting and whooping every time we went through one..it was really funny and we had a good time getting involved!

The journey back from Ooty was fine, the kid behind me threw up consistently through the window, but I felt more sorry for the man by the window behind the kid! Ugh…

We were back in Gudalur by 6 so watched Mamma Mia, the movie. Good times!

Today we had outpatients clinic which was varied, as always. Just to give you an idea of how much variation between specialities and patients there is, I made a list of the first 10 patients that we saw:

1.      Infected scrotal abscess (Urology)

2.      Dacrocystitis (Ophthalmology)

3.      Rectal prolapse (The most disgusting thing ever)

4.      Secondary Infertility (O & G/ Fertility)

5.      COPD (Respiratory medicine)

6.      2 year old child with delayed milestones and microcephaly (Paediatrics)

7.      Really, really bad Diabetic Foot Ulcers (Endocrinology)

8.      Osteoarthritis (Orthopaedics)

9.      Renal Cell Carcinoma (Nephrology/Oncology)

10.  Gout

Told you it was varied! We also managed to recruit quite a few pregnant ladies to our study, which was good. The scrotal abscess needed debridement as it was very necrotic from the infection and we observed this. It was done under sedation, not anaesthetic and we felt very sorry for the man’s poor scrotum!

So I have to go now as we are cooking dinner tonight for many, many people! We wanted to have a dinner to say thank you to Dr Shyla and Dr Nandukumar and some of the staff of the hospital who have helped us and taught us a great deal and who made us feel so welcome while we have been here. Turns out, that has been quite a few people so we have a lot of food to cook! Luckily, Duana is keen to be in charge of the main meal, Dr Alice and her boyfriend Alan who is visiting from the UK are making refrigerator cake for dessert (I’m really looking forward to that!) and I am in charge of Guacamole and tortilla chips. I had a hard time getting hold of avocados and had to substitute potato chips for the Doritos, but I managed to get all my ingredients, so need to go and make it quickly before the guests arrive!

Bye!

Long Weekend in Fort Cochin, Kerala

Kerala is beautiful. It is really, really green and the weather is much better than here in Gudalur! I think it is because we are in a valley in the mountains in Gudalur, it is never really that warm or sunny. But Cochin had perfect warm and sunny weather all weekend. We stayed in a homestay, Spencer homestay to be precise, as we had read in our trusty lonely planet guide that these tend to be good value. And it really was. We had a double room with 2 extra mattresses and it cost us 250 rupees each a night, which is about £3.50! I have found that the pound goes so far here, which is really helpful when it comes to travelling, as my budget is quite tight! There was a bit of a cockroach problem in the bathroom, but we dealt with it. Well I dealt with it, the others wouldn’t enter the bathroom until it had been screened by me first and all pests exterminated or removed! But apart from that, the room was fine and we didn’t spend much time there anyway.

On Saturday we were up bright and early, eager to explore. We hadn’t managed to see anything on Friday, as it was so late when we arrived. We were staying in Fort Cochin, which is where most of the tourists stay, and although it was quite touristy it was really pretty and there were some really nice cafes. We breakfast-ed at a place called the Kashi Art Café where I ate the best breakfast I have had since coming to India. I told you that Mala is a really great cook, and she is…but South Indian breakfasts aren’t really my thing. They often involve fermented rice in the form of balls – called idlis or pancakes – called dosa, and are eaten with curry or chutney. I can never bring myself to eat them for breakfast so we have got through a lot of nutella in our time in Gudalur. And since only one shop sells it as it has to import it, supply is limited and we had been cut off for a few days before our trip to Cochin, so our breakfast at Kashi Art Café was truly wonderful. I just wanted to give you some background to how appreciated it was! We have also been having serious protein cravings mainly meat, egg and chees (well, me and Mona and Julie, Duana is a veggie and she doesn’t like cheese much…weird.), and so when we were able to satisfy these on our trip we were very happy! For breakfast I had a cheese and tomato omelette with thick brown toast and butter and fresh pineapple…I would definitely recommend Kashi Art Café if you are ever in Fort Cochin!

Anyway, enough about breakfast, we spent the morning and early afternoon sightseeing in Fort Cochin. Fort Cochin had previously been colonised by the Dutch and so there were various colonial influences and a Dutch Palace that we paid a visit to. It was a bit of a way away so we took a rickshaw, much to the relief of the numerous auto-rickshaw drivers who had been frustrated all day with our desire to walk everywhere. They were quite funny actually, constantly driving past us saying ‘Ferrari Ride?’ or ‘Lamborghini (don’t know how to spell it) Ride?’ Its low season at the moment so I think they were all very keen to get work. Even though we asked to be taken to the Dutch Palace, our driver had ideas of his own. He took us to a ginger factory and various Hindu temples on his customised tour before taking us to the palace. He even had a comment book from previous tourists he had given tours to as evidence that he gave a good tour! When we eventually got there, the Dutch Palace was not that impressive from the outside, but the intricate Indian wall paintings and murals inside were great. In the evening we decided to go see some Kathakali dancing, which is the traditional dance of the region. Kathakali dancers have to train for 5 years before they can do paid performances, its quite a skill- but more because of the many, many various hand and eye movements which mean different things. Some of the eye movements that they did were really crazy, like spinning their eyes round and round! There wasn’t much of what I would consider dance though! But it was really interesting. The make-up and costumes of Kathakali are also really important and it takes them 1 hour before the performance to apply it, so people turn up at 6 for a 7pm performance to see it being applied. You can see below!

 

After the performance, we went to an Italian restaurant for dinner…it wasn’t very good Italian food and they didn’t serve wine but we still enjoyed it a great deal- a nice difference to curry curry curry! I also had my first ice cream since coming to India – words cannot even describe my joy. I love ice cream and cannot usually cope without it for prolonged periods of time! After dinner we hit the town, another first since arriving in India. I was in no way prepared for the dancing! It was a crazy melange of bollywood dancing, aerobics, and random exaggerated moves – all very active. Kind of the way I dance alone with my music very loud in my bedroom…I never thought I would get the chance to dance that way in public, but I did! We started off dancing conservatively, as we would in London, but it just looked like we were standing still compared to everyone else and eventually we decided to join them…it was very fun!

On Sunday we had a very chilled out day. We paid to use a fancy hotels swimming pool and we swam and read and I ate an amazing cheese sandwich. I realise I am mentioning food a lot, and it is not that the food in Gudalur isn’t good because it is, Mala makes really yummy curry…we are all just a bit fed up of spicy food and rice! We also did some shopping and I bought my mum a present, (although I can’t say what as I recently found out that my mum reads my blog!)  Later on, we went to see the Chinese Fishing Nets, which are the nets they use, inspired by the Chinese ones, to catch fish. Fort Cochin is right by the sea and so they catch lots of fish and sell it fresh and you can get it cooked at local restaurants. It’s a lovely idea although we were too full from lunch to do it!

The Chinese Fishing nets at sunset made for some stunning photography…

On Monday we took a houseboat tour of the Keralan Backwaters…it was very peaceful and beautiful.

 Photos to come...Internet being really slow! 

We departed Cochin at 5pm and arrived back in Gudalur well after midnight! What a weekend! :)

Week 2 in Gudalur

WEEK 2

Wednesday 17^th August 11

So I really am not doing well at keeping this blog up to date! Its half way through week 3 and I am only just uploading my blog entries from week 2! Sorry!

MONDAY

Our second week was great. Monday was relatively uneventful but in the evening we had a cooking class with Dr Shyla at her and Dr Nandukumar’s house. It was lovely, and the food was delicious! We made a chickpea curry with this bread called puri – which you have to deep fry in lots of oil- but is just so good! It is quite an art to get them to puff up just right, you have to keep pushing down the little air bubbles that develop in them and then let them go and the whole thing puffs up. It is hard to explain, but Julie was really talented at it!

For dessert we made something called Bison(?), which is vermicelli in milk and cardamom…heavenly! I will definitely make it again back in England! It was also really nice to be invited to the doctors’ house and to hang out with them- I have never really had that sort of relationship with any doctors I have worked with before. We have also got to know a lot of the staff at the hospital as its quite small, which is really nice. A lot of the nursing students come to yoga and we are now friends with them…well as friendly as we can be in that they don’t speak much English and we don’t speak much Tamil! It was hard to break the ice as they are all quite shy but at Tuesday’s yoga class there was an incident of confusion over a yoga mat between one of the nursing students and myself, which left her feeling very embarrassed! She looked so sweet I gave her a hug and since then we have been friends and smile at each other in the corridors. I think her name is Shoba or Shober…I need to check with her again tonight at yoga class!

TUESDAY

So Tuesday we had yoga but we didn’t do very well as we were so tired from our day of trekking from village to village! Basically, the hospital serves many different tribal villages and the Karnatakan tribe live deep in the jungle. In order to reach these people the hospital runs an outreach mobile clinic each month as near as possible to serve the maximum number of tribal people. In addition to this, one of the Karnatakan people has been trained by Dr Nandukumar and Dr Shyla to act as a health animator. It is his job to visit the various villages once a month to see if there are any problems, check on the nutritional status of the children, the health of the sickle cell patients and to ensure patients are taking their medicines. His name is Sree…something. It’s quite hard to pronounce so he gets every one to call him Parsu. Everyone calls him Parsu the Great. And he is! He is a very small, very funny man and we spent the day with him on Tuesday while he did his village visits.

He is the man on the right.

It was really interesting to see how the Karnatakan tribals live. They were very welcoming and let us see inside their houses. Although their homes are in such a lovely setting- amongst the natural beauty of the jungle, they are quite small, usually just one room, with no windows.

About 10 people, usually 2 families, live in each house and they cook indoors on an open fire. Because there isn’t much ventilation – it can get very smoky. Most of the women and children were at home and some of the men, but many of the men were at work. Many of them work as tea pickers on nearby plantations. The women and children seemed quite bored and many of the women chew beetle nut to pass the time. We did a lot of walking and so were pretty tired by the end of the day, but a real highlight was eating lunch on the grass high up in the hills looking over the spectacular view.

WEDNESDAY

Wednesday was a very exciting day medicine-wise. We had a day of surgery at the hospital. This doesn’t happen often, only once or twice a month depending on the number of patients, as the hospital doesn’t have an anaesthetist, so an anaesthetist has to come from another hospital. We had a visiting anaesthetist from Bangalore on Wednesday and there was a theatre list of 5 patients, 2 female sterilisations, a breast biopsy, haemorrhoids surgery and a skin graft. The skin graft surgery was the most fascinating, as I have never seen one before. The patient was a young lady in her twenties who had been cooking on an open fire and had backed into it. She had very severe burns to both her legs. This is quite a common problem here as most of the tribal women cook using an open fire and tend to wear synthetic nylon saris, especially in the monsoon season as they are quicker to dry than cotton…cotton NEVER dries here! You may remember I told you about the other lady last week whose sari had caught fire whilst cooking and who had burnt her entire chest and neck. She was also due to have a skin graft on Wednesday but she was too scared and decided not to have surgery. However the lady who did have the skin graft is recovering well and the grafts have taken. They are worried she has developed an infection and we took swabs for culture yesterday, she has been started on antibiotics and hopefully she will overcome any infection quickly so that the grafts aren’t affected. Mona took photos of all the stages of the surgery and is photographing the recovery process and plans to do a photo diary, when she does I will post the link.

I got to be first assistant in the second female sterilisation surgery, and I really enjoyed it. I even got to close at the end, which I have never done before. I have only ever practiced sutures on foam models and tablecloths, so I was very nervous, but I think I did a good job!

Thursday we had outpatients and we managed to recruit lots of pregnant women to our study, which was good. At lunchtime a performance group that work for the government promoting HIV awareness came to the hospital. They set up their van and speakers outside and there was a band playing music and singing about HIV whilst others danced. One of the dances was very strange and involved them dancing with pots holding plastic parrots on their heads, but I later found out that this was a traditional dance of the region! It was really entertaining and drew a large crowd of tribal and non-tribal people. It was a really effective way of educating people about HIV and reducing the stigma. They also handed out colourful leaflets to all those watching with more information. I was really impressed. 

 
Thursday was also the day of our last yoga class with Mahesh. He is the Ayurvedic doctor who I told you about who is also great at yoga and has been teaching us every other day. He only spends half the month here in Gudalur, the remainder of the time he spends in Bangalore. But I think that he has taught us well and enough to keep going with our practice. We have arranged with the nurses to continue to meet every day at 5pm to practice together.

Mahesh reluctantly agreed to let us have a photo with him as it was our last class!

FRIDAY

I managed to write quickly about last Friday, we spent the morning at a newly developed school for tribal children who have been made to leave their previous schools for a number of reasons. We did health checks on all the children and it was really fun to spend some time with them. The main problems were bad dental hygiene, mild ear infections and scabies. There was a lot of scabies! Scabies is a mite that spreads easily and causes lots of skin itching. If one person has it you treat all their close contacts as they probably have it too. So we treated them all for scabies. They were really sweet and they loved having their pictures taken by us on our digital cameras and then looking at them. Dr Mrdula also gave them a talk about good dental and general hygiene and then they sang us some songs, which was lovely! They then wanted us to sing, so we taught them wheels on the bus and heads, shoulders, knees and toes. It was a really good morning. We came back to the doctors’ mess for lunch and set off mid-afternoon for our long Independence Day weekend in Cochin, Kerala. It was a LONG drive. But well worth it! Next entry will be about that! Bye for now :)

Week 2 has flown by!

Week 2 has flown by!! I can't believe it is Friday! I have lots to tell you about  and have been writing my blog on my laptop each day but have left my memory stick in the mess so can't upload it even though internet is working for a change! So annoying! But don't worry- I will upload it on Tuesday, internet permitting! It is 2:35pm on Friday afternoon here and we are leaving in 15 minutes to go to Kerala, the next state along to the West from Tamil Nadu. We are going to a place called Fort Cochin which is 8 hours away so we are in for a long drive! It is Independence Weekend so Monday is a bank holiday. We will be back late Monday so will write all about it on Tuesday!

Have a wonderful weekend!

FIRST WEEKEND IN TAMIL NADU - MUDUMALAI NATIONAL PARK

It is Sunday evening and I write this lying on my bed in the doctors quarters. I can hear all the sounds of nature from outside; the bugs make SUCH a lot of noise! One in particular sporadically makes a noise very similar to a car alarm it is so loud! But it feels peaceful, and I am feeling very content.

We arrived back here about an hour ago, having spent the weekend at Mudumalai National Park and Tiger Reserve –which is basically a huge – I can’t remember how many hectares – but huge forest full of tigers and leopards and panthers and wild dogs and bison and spotted deer and mongooses and porcupines and peacocks (fun fact: national bird of India!) MONKEYS and ELEPHANTS J My favourites! They were all roaming free, and although we didn’t get to see any wild cats, we saw everything else! 

We stayed in a place right at the edge of the reserve- which was a really nice sort of camp/resort with cabins that had HOT WATER- which was incredible after a week of freezing showers or boiling hot water over the stove and using a bucket! I had three hot showers in two days…it was heavenly! However as it was basically on the reserve, we had to have two male escorters to and from our room after dark because of the wild animals (usually wild dogs and leopards) that sometimes decided to stop by! I don’t know what they would have done had a leopard jumped in our path – I guess maybe just make us stop screaming! The people were really friendly and we had a really nice time. We were taken out by two of the guys in a jeep to the elephant camp where we got to see the elephants that had been trained being washed in the river and fed a massive amount! The people here seem quite concerned about elephants and talk about them as being the most dangerous of the animals around – far more so than tigers or leopards, however I think my past experience of elephants having been shows at zoos where the elephants spray the audience with water and seem super friendly and cartoon elephants from the jungle book, my opinion of what elephants are like was very different until this weekend. It was explained to us that the reason elephants have started to be more disruptive is that their ‘corridors’ the paths they use to get around, have been disrupted by humans and so they have gotten confused – kind of like a human with an out of date sat nav- and end up where they can cause trouble. We met one elephant at the camp who had killed 15 tea pickers in Kerala about 10 years ago by crushing them. You could see all of his bullet wound scars from where they had tried to kill him. They didn’t succeed and the government then decided to catch him instead and move him to this ‘camp’ to be trained. And he is a really lovely elephant now! But it just made me really realise how dangerous they can be in the wild. After the camp the two guys – whose names I can’t remember, (I’m sorry – Indian names can be really hard!) took us on a drive through the reserve- kind of like a safari. It was great! As I said, we saw loads of animals and the best part were all the wild elephants that we saw, just bopping about, doing their thing- eating and hanging out. They are such beautiful creatures and it was wonderful to see them in their natural habitat. It got dark whilst we were driving and by the time we were en route back to where we were staying it had gotten completely dark – so much so that we didn’t realise we were really close to a mother elephant and her baby until we were right up close to them! They were about a meter away! We tried to take photos but it was a bit tricky as it was so dark – also the mother did not like this AT ALL and went to charge after us! We laughed about it afterward – but our two drivers did freak out and drive away really fast! A narrow escape!

As it is Sunday today that means a day off for Mala (our lovely cook and general looker-afterer) so on our way back to Gudalur we stopped in town and bought hot Parotas (unbelievably delicious round breads) fresh off the hot plate and some bananas and pineapple from our favourite fruit seller and we had a parota and fruit feast for dinner…yum yum. I’m feeling all sleepy lying on my bed so think I’d better leave it there, I am going to go to the hospital now to see if the internet is working so that I can upload all my blog entries! It really has been so unreliable which is why I haven’t been able to, so fingers crossed! Bye for now!

UPLOAD OF BLOG ENTRIES SUCCESSFUL! Yay :) Photos of the weekend to follow! Off to bed to get a good sleep ready for week number 2! Goodnight xxx

FIRST WEEK AT GUDALUR ADIVASI HOSPITAL (August 1st-August 5th)

Sorry! It is Friday. We have had our first five days at the hospital and I am only sitting down to write about it all now! I apologise! My lack of blogging has been due to a) multiple power cuts – average 2 a day, average duration 1 and a half hours! b) Internet not working c) lots going on! But I have made notes in my notebook so I will make sure not to leave out any important details!

I guess I should start with day 1, Monday, our first day at Gudalur Adivasi Hospital. 

At the bottom of this post is a picture of the hospital…just in the distance beyond the ambulance up a muddy hill is the doctors quarters where we are now staying and where we eat all our meals – so only a very short commute to work!

MONDAY

Our first day at the hospital was great. We met the two doctors who started up the hospital, Dr Nandukumar and Dr Shyla. They are a married couple who trained in India but who spent a long time working in America. They are both super doctors and really are the foundation of the hospital. We spent the morning in the outpatients department with Dr Nandukumar. I say outpatients, but it’s a small room, which we have found is A+E, plus a theatre, plus outpatients, all rolled into one!

Monday was a very busy day in outpatients and they see everything in all clinics- there are no specific clinics like we are used to – so we saw a huge range of problems in one morning and Dr Nandukumar had such knowledge of everything in order to be able to treat everyone. In the UK, the patients would have been seen by different specialists but they don’t have that luxury here. It was very interesting for us as we jumped from thyroid problems to rheumatoid arthritis to depression to haemorrhoids to sickle cell disease, just to name a few, all in a couple of hours. We also had some teaching on neurological examination in the afternoon from a lovely doctor who everyone calls Abu. He has the nicest, funniest laugh I have ever heard in my life! Teaching was based on a tribal woman in her 40s who had had a stroke. It was interesting to see how differently she had to be managed because of the limited resources available. The nearest CT scanner is about 4 hours away and so they were managing her uncertain of whether it was a haemorrhagic (bleed in the brain) or ischaemic (clot in the brain) stroke. In the UK, a CT would most definitely be done as soon as possible for all patients to differentiate between the two and then they would be managed appropriately as the management is different for each type and also depending on how many hours since the stroke occurred. However, as they were not able to do this due to the distance, expense of sending the patient and also the fact that the patient wouldn’t go anyway, they were managing her supportively and following a watch and wait approach. If she gets worse over the next week they will assume it was an ischaemic stroke and start secondary prevention with aspirin. They do not have any physiotherapists at the hospital but the nurses taught her some exercises to do, as the stroke had significantly affected her left side, specifically her left arm, which she could not use at all.

After our day at the hospital we went for tea and Indian sweets in town with Alice, a really friendly, chatty junior doctor from England who has been working here for 6 months. She did her elective here a few years ago and loved it so much she has come back as a doctor. A patient in the hospital who we have not yet met has had severe full thickness burns to 25% of her body. This is very severe and in the UK she would be taken to a specialist burns unit for sure. Even here they know that they don’t have the facilities to provide her with the necessary care but she is refusing to be transferred to another hospital as she wants to remain in Gudalur with her family nearby. That’s something I learnt today about the hospital actually- there are no set visiting hours and no limit to the number of visitors that each patient can have, as that is one of the many factors why the Adivasi are reluctant to use the government hospitals. So anyway- she wanted to remain in the Adivasi hospital and she needed a blood transfusion. There is no blood bank at the hospital and so the families of patients are often asked to donate blood or the hospital staff donate blood when necessary. They have facilities to screen the blood and it is given fresh. The woman’s husband disappeared when they asked him and has not been seen since, and so Alice very kindly donated a pint (?) of blood as she was a match. She was subsequently feeling a bit shaky, so we went to a café called Lulu Bakes for tea and the sweetest cakes and sweets I have had! I am going to get my blood group tested so that I can also donate blood if they need me to and I think that Mona and Duana will too.

TUESDAY

On Tuesday morning we had some suturing teaching from Dr Nandukumar who was absolutely horrified to learn that we practiced suturing using new and non-expired sutures, here the students use a curved needle and thread! He showed us the sutures that they use for patients and all of them had expired, many by several years. This isn’t necessarily a problem although they do check the strength of them before they use them, but it better explained Dr Nandukumar’s horror!

Whilst we were in the middle of this suturing session they brought in the burnt woman that I mentioned. Her burns are by far the worst I have ever seen. They were all over the front of her chest and neck, up onto her chin and down her arms. Her nylon sari had caught fire whilst cooking on an open fire. It was so sad and she was obviously terrified. We had no idea what was going on, one minute we were practicing suturing on a tablecloth and the next they were readying the room for a debridement of this womans burns. This is basically where they remove all the necrosed tissue that forms in the healing process. They need to do this to keep the wounds clean so that she can have a skin graft. As they don’t have an anaesthetist here, they were using something called ketamine, which is a sedative, in order to carry out the surgery. It was just so unbelievably different to any surgical procedure I have ever seen. They didn’t wear scrubs or masks although they did use sterile gloves. But they didn’t use sterile gowns to cover her, just her own shawl. In the UK there is no question that there would have been much, much, much better infection control and there would have been an anaesthetist who would have very carefully monitored the patient throughout. The only form of monitoring that the patient had was a pulse oximeter. The reason ketamine was appropriate was a) it doesn’t lower the pulse ox and BP in the way that other anaesthetics can and b) it is very short acting, so if there were any complications with it such as a reaction of the patient to it then these would have been short acting also. However it meant that Dr Nandukumar had only 15 minutes to debride a very large area. Throughout, the patient was moaning and making noises as if she was very much in pain, especially when they were trying to flex her neck which is particularly bad. I know that due to the sedative she won’t remember this but normally in theatre patients are completely unconscious and so this was a very strange experience for us and I think we were a bit shocked for a while after, especially as we had not expected it at all. She currently doesn’t want to have skin grafts, especially as her husband is not there, so all they can do is keep the burns clean and see if she changes her mind. I think they are going to start using aloe vera on them, which both soothes and has antiseptic properties.

Tuesday was also the day of our first yoga class!  There is a Ayurvedic doctor named Mahesh who works at the hospital. He is small and has a big moustache and is an absolute legend! Anyway – he is amazing at yoga and when we found this out we managed to convince him to give us yoga classes. We have them every other evening at 5:30 and have managed to get loads of nursing students, nurses and a doctor to come along- he now has a bit of a cult following! So first class was Tuesday and we learnt the ‘sun salutation’ which comprises 12 different movements. I didn’t realise how much breathing was involved in yoga, and also how peaceful it is. I have only ever tried pilates which is a lot more active. I really, really enjoyed the class and am very glad that Mahesh has agreed to be our yogi! However, I did nearly fall asleep when he asked us to lie with our eyes shut and relax each part of our body in turn- I was just so relaxed!

WEDNESDAY

Wednesday was quite an uneventful day. We spent some time finalising the questionnaire which we are going to use to do some research whilst we are here into hypertension in pregnancy. In order to do this, we plan to check the urine and blood pressure of every pregnant woman attending the hospital whilst we are here, as well as asking our questionnaire, which evaluates potential barriers to these women to accessing healthcare. Hopefully it will be interesting and we aimed to start on Thursday, so we had to get that sorted out.  We also had a bit of a group meeting to discuss our weekend plans and we decided to visit the Tiger reserve and National park which is about an hour away from here. There are lots of wild elephants there! 

THURSDAY

Today we spent our day doing our study, checking the BP and urine of all the pregnant women that came to the hospital. There were quite a few so this kept us very occupied.

We also had yoga class number 2, which was great, except I fell asleep during the part where you are supposed to relax your whole body one part at a time! It was so embarrassing! My supposed friends Mona and Duana didn’t even poke me to wake me up - they just let me sleep. Now all the nursing students laugh at me when they see me!

FRIDAY

On Friday we drove with some of the doctors from the hospital to one of the community centres, which was about an hour and a half away. There are a number of these centres and at each there is a ‘health animator,’ a member of the tribal community who has been trained to recognise signs and symptoms so that they can identify those who need medical attention. They can either refer patients to the main hospital or arrange for them to come back when the doctors are coming if it isn’t urgent. It is really an excellent system because we have found that many people don’t know about worrying features of illness. For example- so far of all the pregnant women we have spoken to – none of them knew of any medical complications in pregnancy. However the health animators are aware of these and can recognise them in the women that they see. I have lots more to tell, but the electricity has just gone - so am off on a candle hunt! I will write again after our weekend at the National Park! Happy Weekend! xxx 

THE RAIN IN GUDALUR

Ok – so we are back from town…it started raining whilst we were there so it became very difficult to ‘purchase’ – they call shopping  ‘purchasing’ here…I quite like it! The town is a lot bigger than I thought it would be. I was trying to prepare for all eventualities when I was packing as I didn’t think that I would be able to get anything here and that we would be in the middle of nowhere- but that is not the case. Although the town is kind of in the middle of nowhere – there are a fair few shops and places to eat in town. We don’t need to cook for ourselves though as there is a lovely local lady named Mala who comes each day to make our meals. We met her this morning at breakfast and she is so kind and smiley! I will try to get a photo of her!

The picture above shows Gudalur town and a tuk-tuk (aka. Auto-rickshaw) can be seen, which I did such a poor job of describing before!

The rain...!

We took shelter in a fruit shop and bought lots of yummy fruit. The bananas here are teeny-tiny but taste absolutely delicious!! You need to eat about 3 or 4 to get a normal-sized bananas worth, but they are so good! I have already eaten about 6 of them!

I will write again tomorrow to tell you about my first day at the hospital, but bye for now!