Answers on a postcard

This week I have been out and about on the mobile clinic again. This is always something which I find enjoyable and probably second only to spending time in the labour ward in terms of my favourite shifts.

On Monday I was out in one area surrounded by tea plantations and the health animator had brought his 11 year old daughter along. In our charity community program a health animator (for those who are unfamiliar with this slightly holiday camp sounding job title) is a health worker who is from the tribal community and instrumental looking after patients in the field at a grass roots level. While the schools are on holiday a number of them bring their kids along on field visits.

To divert off topic for a minute, this is something that I have noticed a lot during the long school break that we have been having. In our area of India it is not considered strange to bring your young children to work with you. It seems to be a great idea because it allows them to see where their parents go all day and removes the concern about paying for childcare. Although I can’t see it catching on in the UK, from my experience our young are just a little too badly behaved for this.

Anyway the point of this short anecdote, for those of you who are wondering, is that during the day there were many times when this little girl and I were left to our own devices together, one example being when her father and the driver went off into the village to recruit patients for the clinic. At these times this very sweet and self-assured young girl took the opportunity to practice her English on me, and correct my Tamil. I thought you might be interested to hear some of the questions a bright and inquisitive tribal pre-teen girl had for me.

First came all of the routine questions, what country I was from, my full family tree with names and occupations supplied for each member etc. But then came some slightly different questions.

Girl: “In your village do you see elephants?”

Me: (trying to picture large pachyderms cruising the Lustleigh cleave) “erm no we don’t have wild elephants in England”

Girl: “Oh, what animals do you have?”

Me: (trying desperately to think of some interesting animals and failing) “foxes we have… “

Girl: (trying to help me out) “and dogs?”

Me: “Yes, dogs and cats and sheep and cows”

There then followed a little discussion about whether we had puppies in England because she likes puppies, I told her about our new puppy and she seemed pleased with this information. She also wanted to know what variety of cows we had, a question I did my best to answer. The general topic then moved to clothing.

Girl: “In England do you always where a Salwar Kameez?”

Me: “no, mostly I wear skirts and tops or dresses or shirts and trousers”

Girl: (incredulous) “The girls wear trousers?”

Me: “yes quite often”

Girl: “Do you wear Saris?”

Me: “no, not really”

Girl: (looking a little shocked) “but what do you wear when you get married?”

There then followed me trying to explain U.K. wedding dresses, an endeavour which ended up including a rather poorly drawn illustration. “Ah” she said knowingly at the end of this “you wear a frock!” and I guess we do usually. After this she told me a little about her grandfather’s house which was surrounded on all sides by tea and asked me what food grew near where I was from.

Me: (thinking of the two lovely fruit trees in our garden) “We have apples”

Girl: “and bananas?”

Me: “no, we can’t grow bananas in England it’s too cold”

This won me a seriously sympathetic look from her. At the time I thought to myself that it was sweet and naive of her to imagine bananas sprouting in the green and often rather cold climate of the U.K. Although later on I told this anecdote to one of the Indian doctors here and he said “oh you can’t grow bananas at home?” and it made me realise that things that I take for granted are not necessarily particularly common knowledge. Yes we have no bananas!

The conversation then turned to our houses, where they big? (Yes sometimes), did they have grass roofs? (also a yes sometimes, thinking of the thatched cottages in our village at home). Did we have rivers in England? (Oh yes certainly) did we bathe in them? For this I was stumped for an answer. If she meant swimming then the answer was yes, in the summer we would often go to a river for a dip, however many people here in India bathe more literally in the rivers, with soap and shampoo and a towelling down at the end of it. I tried to ask her what she meant but she hadn’t heard the English word “Swimming” before so we got a bit stuck.

The last thing she asked before the clinic started really made me chuckle.

Girl: (pointing at my freckles) “what happened to your arms?”

Well I tried my best but how do you explain freckles to someone who has never come across them before?

Until next time then, lots of love from one very freckled lady far away from home.

A x

Rat Curry...

There is a rat living in the refrigerator. The fridge in question is the one situated in the doctors’ hostel where I live. The rat in question is a medium sized pale brown fellow.

A couple of days ago I had stored half an avocado in the aforementioned fridge to eat later and when I went across to retrieve it the rat was just sitting in the little shelf in the fridge door. Needless to say I was a little taken aback and I emitted a noise so shrill that (when they realised what had happened) the people in the next room asked if it was me or the rat which had squeaked. I was ashamed to report that it was in fact me.

At first we thought that perhaps the rat was just visiting the fridge but evidence actually points towards it inhabiting it in a more long term fashion, it obviously likes the air conditioned lifestyle. With this knowledge last night I was making a cup of tea. The milk was in the fridge and I knew at some point I would have to open the door however I could hear the little tyke in there rummaging around eating his dinner (previously our dinner). Strange as it now sounds my method of dealing with this seemed very natural at the time. I knocked on the door of the fridge to allow the fridge dweller time to scurry into his hole. We assume he lives in the lining of the fridge while not at dinner. It was only in retrospect that it seemed a little odd to be knocking before opening the door to my own fridge, but there you have it.

Anyway the housekeeper/ cook who runs our hostel like a very tight ship indeed has now been informed and seeing as the first line of management (i.e. a full clean out of the fridge with more rat tight vessels) has failed it would appear our old fridge’s days are somewhat numbered!

On the topic of food and our lovely cook it happens to be her day off today so without further ado I am off into town to buy some ingredients to cook dinner. I have some vague plan to attempt Thai Green curry and I will let you know how I get on, I may even supply pictures!

Hope you like this short rat based report. Lots of love to everyone at home and I look forward to seeing you when I visit England in the summer, less than 6 weeks now!
A x

p.s.

I feel that this note deserves a post script to tell you all how events panned out.

When I suggested to my friend, the other junior doctor here, that I cook for a change his eyes lit up and he enquired whether the recipe was going to involve some meat. Both he and the other doctor currently staying in quarters are omnivorus and like a bit of "non-veg" when they get the chance. Here in our fully vegetarian doctors mess that chance is not frequent.

At first I was a little bit nervous about this, I am not a big meat eater at the best of times and I have seen the chicken stalls in town and to be frank they don’t look too sanitary. But my friend knew a place where he said the chicken was good and we agreed on a chicken Thai green curry. I said that if he could it would be better to get chicken breast and preferably boneless. Just enough for three people was the plan. What he brought back from the chicken stall was almost one entire chicken which had been plucked, skinned and then attacked with a very large knife. Ribcage, heart, lungs, neck all were present and anatomically intact enough to be recognised.  When I recovered from my shock I was in some ways quite impressed at the way that nothing from the chicken is wasted in India, unlike in the UK where sterile looking battery farm chicken breasts reach the general public in little Styrofoam dishes covered in Clingfilm. However this didn’t solve my problem that we had way too much chicken.  

Luckily my side of the shopping had also gone a little differently to my original plan. Buying small quantities in India is difficult bordering on impossible and I had way too much of all the other ingredients too. So I just cooked what we had and the final product was enough Thai green curry to feed a small army. Doing our best to remove the bones we ate our fill and there was still plenty left. So we sent one large tiffin box full down to the nurses in the hospital (Tribal people being generally non-vegetarians it went down quite well) and saved enough for our housekeeper and her assistant to eat it the next day. Interestingly despite the fact they run a completely vegetarian kitchen they both cook and eat meat at home. The feedback I received was constructive and not entirely critical, all I needed it seems was to add more salt, more pepper, and more chillis!

On the fridge invader front our little friend has been evicted along with his old pad and a brand new shiny refrigerator is now standing pride of place in the kitchen. Generally speaking a good result, although perhaps not for the rat and certainly not for the chicken.

 I forgot to photograph the curry so instead here is a photo of a very handsome rooster from one on the villages. I felt it was a fitting accompaniment!

About Time

When I was living in England time felt mostly linear. It was a flowing river of minutes hours and days from here to there (wherever there was). Occasionally a long stretch at work or a complicated shift pattern (especially one involving nights) would warp it somewhat, telescoping from one island of relative freedom (be it weekend or holiday) to another. I would be busy caught up in something and the little raft signifying my concept of “now” would rush along the river, days passing without me realising.

Here in India my already slightly vague concept of time has been shaken significantly. Having heard and read other westerner’s experiences in India this is by no means an unusual experience. India rushes along from day to day, week to week with sun rising and setting, moons wax and wane like any other country but time itself does not seem to be as firmly set as other places, particularly in comparison to the U.K. It does not run from A to B.

Some people explain this Indian concept of time as cyclical. When you consider the widespread Hindu belief if reincarnation you can understand why time might go in circles. From birth through childhood to the point in adulthood when you have your own children, then old age and grandchildren, then death and ultimately rebirth, forever looping around into infinity.

To our tribal population, even more than most Indians, time is an abstract concept. A very practical example of this is if you ask the age of a tribal patient. At best you get a general answer which you can almost guarantee is a guess. The woman glances around at her young children and pronounces herself 25, or the girl who has just got married tells you she is 19 (although she looks about 15). More often you just get a blank stare as though you were asking “what is the square root of 47?” age to them is entirely irrelevant. Traditionally birthdays are not celebrated, or even known about. Although there is no shortage of calendars to follow here with the western, the Tamil and the Malayalam months running at different times they really don’t care much for dates. So you might ask a mother when her baby was born and rather than getting a day and month she will say “just after the neighbour had her baby” or “before the last rainy season”. Very often I will be trying to ascertain the duration of a patient’s symptoms and stumble into trouble with the timings. I ask a patient with fever how many days he has had it and he answers “night time”. At first I thought it was my rather dubious linguistic skills but even the doctors who are fluent seem to find it difficult to pin down time periods.

I must admit in some ways this relaxed attitude to time can be quite appealing. So here are a couple of interesting things which have happened recently and I haven’t placed them in any particular time order.

So here is something I found interesting while at work. A visiting paediatric surgeon came to do a day’s surgery at the hospital. Unfortunately as staff levels are low I was needed in the outpatient’s clinic for much of the day but luckily I got to sneak down and watch a bit of the action. There was one young boy having a small lump excised from the corner of his eyelid. At first when examined in clinic this was thought to be a dermoid cyst (a benign lump usually containing skin cells) but at the time of operation it was not behaving like a dermoid would and the surgeon said that in his opinion it was likely to be a cyst due to a parasite infection. Perhaps not everyone’s idea of something exciting but I thought it was cool. Being here has really made me realise how interesting infectious disease is, especially all the tropical stuff. At the moment our small hospital is just developing a microbiology lab. It's going to be really great when it is up and rumming properly and I feel like it will make such a huge difference to our antimicrobial prescribing practice.

Now for something completely different, here is something I got up to outside of work. Our friend at work who just got married finally came back from his honeymoon. Of course we were all very excited to see him and meet his lovely new wife, so there have been lots of lovely dinner parties! This for me means lots of exciting opportunities to eat lovely food while chatting with friends. For one of the parties we made a pudding which one of my friends adapted from a magazine clipping. We took a large amount of fruit and liquidised it to a pulp (mango and banana because they are in season) added equal quantities of cream and milk powder, enough sugar to make it sweet and some milk to get a good consistency then put it all in the fridge to chill. Once it was really cold we topped it off with pomegranate seeds and chopped almonds, it was really great.

So this is a really long letter and I hope you are not too bored. Thinking of you all at home obviously and missing you and wishing you well. I will write again soon perhaps if there is some good fruit at home you could try an adaptation of the recipe, when I get home I want to make something similar but put it into the ice cream maker, I bet that would be awesome.

Lots of love

A x

p.s. here is a photo I took in Cochin a while ago of a nice tree, I know its not recent but I like it and as we are talking about a lack of concept of time I thought it was a good opportunity to sneak in a less up to date pic.

One man's trash

According to the saying one man’s trash is another man’s treasure. Now I am not certain how true a statement this is but it occurs to me that in the UK we don’t think about our rubbish enough. Speaking from personal experience when I am at home I produce a lot of garbage, scraps of paper, food wrapping, plastic bags, bottles and cans etc. I try to recycle what I can but a lot still goes into black bin liners for collection by the council. The problem here in India is that, at least where I live, there doesn’t seem to be a particular system for waste collection. You have no option but to think about your rubbish because it is still very much surrounding you.

I remember the first time I noticed this on my original trip about three and a half years ago. I saw an elderly woman stooped over sweeping up all the rubbish outside the old hospital. She swept it all together into a pile and then, much to my surprise at the time, just dumped it over the wall into the neighbours’ front yard. I presume what happened next was that the neighbours just swept it up again and delivered it straight back, although I can’t be sure.

Today one of the other doctors mentioned to me that the nurses were going to clear up the big pile of rubbish just outside the front gate of the new hospital. I decided to come and lend a hand. The nurses gave me a pair of gloves and we got cracking. It stank. It was an enormous pile of all sorts of household waste. The plan appeared to be to collect all the plastic so we set about it with gusto. We had a big black bag and before long it was full to the brim with all types of plastic junk. The whole expedition had a slight air of holiday about it in some strange way and I barely had time to wonder to myself what was going to happen to all the other rubbish that wasn’t plastic ie all the paper, cardboard, cloth etc when my question was answered. It was shoved into a pile and set alight. Although not ideal this did add even more jollity to the gathering and a degree of risk as it was decided after a short discussion that the fire needed assistance and petrol was sent for.

I can’t deny that fire is fun but it does make you think a little about waste in general. Can we really as a world go on producing as much nonsense as we do and just chucking it away when we don’t want it? It might be quite shocking for me to see a pile of rubbish being burnt in the street (a very common sight here) but really is it any different to our attitude to much of our rubbish at home? We have our landfills and incinerators we just don’t happen to deal with it in such plain view. It is the classic western philosophy of “out of sight out of mind”. I was happy to hear that the plastic at least would be taken to a man in town who does recycling and I do think that trying to clean up our immediate area in a good step in the right direction but there is such a mountain to climb, not just in developing countries but all over the world when it comes to waste disposal and perhaps more importantly minimising the amount of waste in the first place.

Right then, I am off to take a shower because I smell like the bottom of a bin.

Love to you all.

A x

P.S. Sorry about these two blogs going up at the same time but such is the way with my rather erratic internet, I tend to just write when I feel like it and upload whenever I can. Also sorry that there is no photo but I figured that a photo of a rubbish heap might be rather unpleasant.

A week of weddings part 2

So I managed to entirely miss the Royal Wedding, although a group of the UK students did manage to find a TV to watch it on and the lovely Indian lady hosting them even provided tea and biscuits, very British indeed. I must admit I am not too heartbroken at missing the full coverage. I have seen a few photos and that is enough for even the most girly and wedding obsessed sides of my personality. Yes she looked lovely on her wedding day but when it comes down to it most women do look pretty nice on the day of that particular life event.

The wedding that I did experience in full glory on Wednesday however was a slightly different affair (although needless to say the bride looked very lovely indeed). The event I am referring to was the tribal wedding of one of our wonderful nursing staff, which I was lucky enough to attend.

The difference in the style of wedding was quite marked from the outset, starting with my invitation. No gold lettering on embossed ivory card, I was invited in a much simpler and arguably more personal way. Sat here at the desk upstairs in the hospital last week I looked up from whatever work I was doing on my computer to see two of the nurses standing in front of me. The nurse who spoke the better English pointed at her friend and said “Alice Doctor, next week she is getting married. You are coming” this was certainly not a question, more of a statement.

True to this statement I did attend her wedding and I am really glad that I did. I was not the only westerner in attendance with all of the medical students, the girl volunteering at the school and a Dutch social work student here on holiday all joining in. We piled into a big hire car and made the journey early in the morning to the bride’s village. The wedding ceremony was not a traditional tribal one as we might have expected but actually a variation on the Hindu wedding. Short and sweet the whole thing was over quite early. There was just some blessings, the tying of a thread loosely around the brides neck, a chance for us all to throw a small palmful of blessed rice at the couple and then the main event with the bridegroom leading his bride three times around the fire in the full view of the community. Short as it was it was really rather lovely and the bride looked amazing in her red sari and copious jasmine flowers woven through her hair.

After the ceremony itself there was a selection of tribal dances performed for us guests. Every song in their culture has a different dance with unique dance steps performed in a circle around a ceremonial lamp. The music is provided by the clacking sound of the lengths of wood which they hold in each hand and hit together to produce a rhythm. There is something about it which I must admit made me think of Morris dancers at an English fete. Although to be honest they looked like they were having a lot more fun than the average Morris dancer. Each dance seemed to start slowly then gather more and more pace and enthusiasm, finishing with the dancers giving a final cry of joy and then standing sweaty and beaming proudly in front of the audience.

When the dancers had been persuaded that we might have had enough and every one was getting hungry tables were brought out and set in rows in the wedding tent. Always enthusiastic when it comes to food I grabbed a chair next to my friends and was fed in the first sitting. I was quite glad that I had had previous experience with south Indian Thali and therefore didn’t find eating in front of the crowd without any cutlery too daunting. First came the banana leaf, an ideal disposable plate being easily available and fully compostable, then a man with boiled water for you to wash your banana leaf and your right hand. Once you were satisfied with the cleanliness of both leaf and hand the men came around with serving dishes. A small scoop of salt and one of chilli powder in case you thought the food too bland (which in my opinion it was not and at the end of my meal the only thing remaining on the leaf was said small piles of seasoning) this was the first thing to arrive. Then poppadom, chutney, lime pickle, veg curry, samba, chickpea curry, a large pile of rice (always a major staple in the South Indian Veg Meals) curd and a banana. It was amazing. And just when I thought it couldn’t get better they brought round the payasam, a truly delicious south Indian desert which is a close relative of the rice pudding. Totally full and very happy we cleared off to leave space for the next sitting of guests, there were a lot of guests! The wedding feast felt something akin to the feeding of the five thousand but with curry not loaves and fishes.

On reflection this was one of the most genuinely lovely celebrations I have been to. So welcoming and relaxed. I think that this is what a wedding should be, in fact both of the Indian weddings I have been to although very different in many ways have a deep rooted similarity in their inclusiveness, a celebration of two families and their communities.

Anyway on that note, in the spirit of love and celebration I will leave you for now. I promise to be in touch again soon. Love.

A x

Walking the circle around the fire

Tribal dancers