The best of the rest

So I am now back in the UK. I flew in on Friday just in time to have a really lovely sunny bank holiday weekend in the glorious Devon countryside. I don’t mind telling you that it is a very strange thing to be home for the foreseeable future. Already I have this rather heavy feeling of needing to get on with my “real life” (well I suppose it had to happen eventually).

However if you will kindly indulge me I would like to tell you just a little about my last two weeks in my wonderful, noisy, slightly smelly adopted native land of India. Well my last two weeks for now, I know I shall be back before too long. Where I left off last time Alan had arrived and been very rapidly thrown into the thick of it. I would like to take this opportunity to reassure you that I did take some time off from the hospital in order to take him on a little bit of a holiday. The first instalment of this was a long weekend in Kerala, the medical students were going so it seemed sensible to take the opportunity to tag along. I can say now that I am so glad that we did. Cochin, where we had our base, is one of my favourite places ever I think. I have visited a couple of times before but I never get tired of it.

For one thing it is a wonderfully old place, being an ideal strategic position it has of course been occupied and influenced by a variety of different ruling forces. Portuguese, Indian, Dutch, Chinese and Jewish settlers have created a wonderful patchwork of culture and architecture. In modern times it has become more of a draw for tourists and travellers but it still holds its credentials as a naval port and trading post. It manages to be touristy but also retain a degree of authenticity.

 As someone who has been in small town rural India for quite some time the main draw for me and the excitement of my Saturday was the cosmopolitan café culture (obviously with a traveller friendly touch). We had our breakfast at the Kashi art café. You walk through a stylish little art gallery and out the back there is a cool shady walled garden feel. I couldn’t fail to be excited with a menu which included breakfast cake and fruit platter as well as possibly my favourite sweet lime soda in the whole of India. Lunch was at the Teapot café, another spot which I can’t come to Cochin without needing to visit. A beautiful old building with high ceilings decorated with every piece of tea making paraphernalia that you can imagine. For dinner Alan and I snuck off to have some Indian food (the medical students were planning to hit the big city for some clubbing which we didn’t quite fancy). We went to Dal Roti, a first time for me and highly recommended by a previous med student visitor to the hospital. It lived up to its good review with simple but extremely tasty North Indian cuisine. It was also quite interesting because we met a rather lovely but eccentric Australian lady who told us all about her experiences in India as a “Dental tourist” having come over originally for some dental implants she had suffered a rather awful sounding botched job and had to stay for an extra five months or so to get it all fixed. She seemed extremely jolly about the whole affair, I am not sure I would have been quite so philosophical!

Well reader you may be starting to think that all we did in Cochin was eat but I assure you that is not true, it’s just that we did eat quite a lot and it was rather nice. On Sunday Alan and I did a day on the back waters. This was very relaxing as you can imagine, a combination of hot sun, warm breezes and dappled light reflecting off the water. In fact I was so relaxed that at one point Alan assures me I was completely asleep, such is life.

On the Monday (Independence Day in India therefore a bank holiday) we set off for a day at the beach. The beach in question was Cherai beach on another island just across the water. On some (rather brief) consulting of borrowed guide books we decided that the very best way to get there was to take the ferry, then a bus and then walk the short distance from the bus stop to the beach. In retrospect this is not a route I would recommend. The ferry was simple enough after we worked out which ticket counter we needed to queue at but the bus was more crowded than any other mode of transport I have ever tried to take. Think about the tube in rush hour then add half as many people again and subtract any western ideas about personal space. Then factor in the midday heat and humidity of sticky south India. To paraphrase Alan there were small Indian ladies in saris crammed into parts of my anatomy I didn’t even know I had!

After the bus came the short stroll to the beach, unfortunately not as short as we thought it might be and again in the absolutely boiling midday heat. I thought I was being steamed alive and I have never seen Alan that drenched in sweat. By the time we reached the beach all we could do was locate the only air-conditioned resort in a five mile radius and sit down to lunch. After a really lovely meal and a lot of cold drinks we finally motivated ourselves to brave the heat and hit the beach. The lovely thing was that being white and western we were in the massive minority. The majority of pleasure seekers were obviously Indian out enjoying their own coastline on a national holiday. I decided that if I was going to fully enjoy the Indian ocean I was going to do it the proper Indian way and fully dresses in my Salwar Kameez I strolled into the waves to squeal and giggle like the heroine of a Bollywood movie!

Well there you have the highlights of our trip to Kerala, always a pleasurable experience. I might write a quick rundown of the rest of our travels, the last part of the trip was spent in Mysore and Bangalore, but not today. I fear you are probably worn out enough by my attempts at travel writing for now. And besides back here in the real world I need to get on with job applications!

Lots of love and see you soon,

A x

Boys flying kites next to the seaside in Cochin

me wading into the sea

did the tourist thing and let some woman stamp "Henna" on my hand, I think it is actually ink

did even more of the tourist thing and went to see some Kathikali dancing

A change is as good as a rest...

So I always said that I would believe Alan was visiting me when I saw him with my own eyes on Indian soil. Now in retrospect I feel rotten for ever doubting him, true to his word and after 29 hours of pretty solid travel between St Helens Merseyside and this corner of Tamil Nadu he turned up on the doorstep of the hospital. Understandably I was over the moon to see him and had to try and restrain myself from jumping around like an over excited puppy. He had just travelled by bus from Bangalore and needed a bit of a wash and a rest but after affording him an extremely short break I couldn’t restrain myself from taking him on an extended tour of the hospital and a round of introductions.

Having worked ever so hard back home while I have been gallivanting here in the Indian subcontinent you might assume that I would want to give Al a well-deserved rest on arrival. Perhaps do some gentle sightseeing or tourist activity? But you would be wrong. The second day he was here was one of our operating days. We had a visit from our wonderful and eccentric travelling anaesthetist (there is currently no regular anaesthetist on staff) and so a list had been prepared. One of my mentors and the most senior clinician in the hospital is a very enthusiastic surgeon and was keen to show Alan how we do things here. So rather than putting his feet up I had Alan standing very resolutely on his feet for a full day of observing in the operating theatre, with teaching the medical students thrown in for good measure. He was an absolute hit but seeing as he is charming, professional and super brainy how could he fail really?

The next day dawned and you would now certainly expect me to let Alan rest, at least a little but no I had other ideas and bundled him off to see the mobile clinic in action. As the most junior doctor here (therefore more dispensable from hospital duty) and one who’s bones don’t yet mind too much being rattled around in a glorified truck over Indian mountain tracks I have taken over a lot of the mobile clinic visits and I felt that Alan would not have a full idea of what my daily routine here involved without seeing one of these first hand. Our day did not disappoint as it was a classic mobile clinic visit if ever there was one. Small children attending to have their weight charted and check-ups for those not growing as expected. The usual viral coughs, colds and stomach upsets of primary care medicine everywhere. Mostly treated with paracetamol and advice like “drink plenty of fluid” and “if it doesn’t get better in a couple of days come to the hospital”. Some of those with high fevers or who have clinical findings and are systemically unwell warrant antibiotic therapy or direct referral to the hospital and a lot of what I do is try and sort one group from the other. As usual there was at least one really frustrating and upsetting patient who despite being quite severely unwell and despite everyone’s best persuasion techniques just flat out refuses to come to the hospital for investigation and management.

One particular chap who fell into this group had essentially been too unwell to work for two weeks with cough, weight loss, fevers and intermittent vomiting. He looked skeletal and certainly needed us to investigate for TB. But even with us all (The three health animators, Alan and myself) sitting on the porch of his house and trying everything bar just picking him up and carrying him back to the van (he was certainly light enough) he just said he would come tomorrow. I don’t think that I need to tell you that he did not arrive in hospital the next day. Partly I think that patients like this are afraid to come but when it boils down to it we gave him all of the information, that it could be very serious or without treatment even deadly and he made his decision to stay in the village. I don’t for a second think this means that what we are doing is somehow wrong or not working but just that we are still part of a process that takes time. When the charity first started going into the villages years ago the tribal people were so scared that they literally ran away. Now more often than not they seek help and in the next generation I feel confident that patients like this will be more likely to come for the treatment they so badly need. We just need to keep going.

Anyway I seem to have gone on a very long tangent of thought there, hope you don’t mind too much. Friday came and still no rest for the wicked, or for Alan, as we had both been volunteered to take part in paediatric health checks at a new school taken over by the education branch of the charity. All under the full supervision of course of one of our senior hospital doctors. The thirty-odd tribal children in this school range from 5 to 14 years in age and only have one significant uniting factor, they have all dropped out of mainstream government schools. The general atmosphere was one of controlled chaos as the children lined up to be prodded and poked, have their chests listened to and their ears inspected. Because they were living in such close quarters and there were a good few cases of scabies and likely cases of worms we prescribed a blanket treatment for both conditions. Other than that I am pleased to inform that they were mostly in pretty good health and after their check-ups and a little lecture in hygiene and infectious disease from the Indian doctor they treated us all to a few rousing Indian songs complete with hand clapping. The lyrics of course were wasted on the English medical students, Alan and myself but the sentiment was lovely. After they had finished they demanded that we also sing… after a brief team huddle to discuss our options we went for “heads, shoulders, knees and toes” followed by “if you’re happy and you know it” both of which I feel went down splendidly with plenty of joining in from the kids.

Right then this must be far too much chat for now! I will write again soon and tell you all about the trip Alan and I made to Cochin. Until then much love.

A x

As an illustration of this episode of blog I could not resist this snap which Alan took of me doing an examination on a young school kid. In case you are wondering I was trying to encourage her to stick her tongue out and say "Ahh", leading by example!

Magic and green medicine

One of the aspects of the health care which I have great respect for here is the willingness of the hospital staff to be open to traditional medicine. When I first came here as a medical student in 2007 they were at that time discussing having an Ayurvedic doctor on staff. As I am certain that I have mentioned before he was one of the very first people that I met here and a very interesting guy. Splitting his time between teaching in Bangalore and practicing here he has a wonderful passion for his craft and for the tribal way of life. Part of what I find fascinating about Ayurveda is the holistic approach which it has. This type of medicine is not considered as just some compound which can distilled down and handed to you in a pill, it includes all aspects of your life and everything you do with or put into your body whether it be the food you eat, your activity levels or the way you react in certain situations.

In some ways I think traditional medicines work well here because the population are so much more clued in to their natural rhythms and the cycles of nature than the average city dweller. One very florid example of this is the fact that on full moons there are a significantly larger number of tribal babies delivered in the hospital. When I was first told this I scoffed slightly. I figured that this could not really be the case but I must admit that I have noticed the correlation myself. On a normal day/night we might deliver one or perhaps two babies. On a full moon I have delivered up to five in a 24 hour period.

Even though I am open minded about Ayurveda I do like to tease our doctor here and occasionally question his pearls of wisdom. For example you should not mix bananas with dairy products because this creates a sort of “slow poison”. Even if this is true I refuse to believe it mainly because I am a massive fan of banana milkshake! It also appears to me that almost anything in Ayurveda either contains honey or can be mixed with it. I am less concerned about this and far more likely to agree with it mainly because I like honey, a lot.

In the last week our wonderful Ayurvedic doctor has agreed to take us for some Yoga classes at the request of the medical students. I have done a bit of Yoga in the UK with a really lovely instructor who is also a friend of mine so I was not too nervous to join in even though there was quite a lot of hospital staff coming along. It was really great and I am glad that I joined them. Very simple actions and certainly not straining myself at all but I must admit that after a few sessions my muscles and joints felt very grateful for the stretch out.

Over all I feel that natural medicines can be a very positive part of the healing process although not necessarily advisable on their own. Today an elderly lady came in three weeks after a fall onto an outstretched hand. At the time she had broken her wrist but instead of coming to the hospital had gone to a natural doctor in the village who had wrapped it in a very tight herbal compress. Unfortunately this means that now the bones have partially fused in a "dinner fork" deformity which will in all likelyhood permanently effect her functioning. The message here is that we don't want people to stop using their natural medicines altogether, only that we would rather use them in symphony with what we can offer rather than instead of.

The lovely Alan arrived in India last week so in my next blog entry I will be telling you all about his visit so far. I am referring to it euphemistically as a holiday although for a large proportion of the time it has involved me bringing him along to work with me...

Anyway lots of love and catch up soon.

A x

Hope you like the pic, Alan managed to capture this little guy on film. Sometimes life is not fair, I am here for 6 months and within a week Al has a better kingfisher photo than me!

The time has come the Walrus said...

There are many things which life can be said to be, but surely predictable is not one of them. Perhaps too it should be noted that I am not the best at predicting things if my track record is anything to go by. Although in all fairness I think that nobody could have predicted the course of events leading to my premature return home from India.

It is however an inescapable fact that “whatever will be, will be” and at the moment England and to be more specific my family needs me far more than India does! How do I feel about this? Well to limit it solely to my opinions on India and my time here I must admit I am feeling very philosophical about the situation. I have had the most unbelievable time here and I have learnt so much about such a diverse number of topics from medicine, surgery and obstetrics to Indian culture, friendship, cooking and just being. I know for a fact that the door is always open for me to return here, that much has been made clear to me. This small patch of India will always be a home for me as long as it is home to my wonderful friends. I have plenty of work to be getting on with related to the hospital and the projects I have started here and I fully intend to continue my quest to speak Tamil in a comprehendible manner!

What this does mean though is that there are many things which I intended to write about but somehow didn’t find time yet which I will now be endeavouring to convey to you. As a sort of pre-warning you don’t have to try and keep up. You really don’t have to read it all if it becomes boring but I just want to get it down on metaphorical paper so that one day if I decided to read this back I could think to myself “oh yes that happened, I had totally forgotten”.

I will be leaving the country in less than three weeks and I find myself thinking back to all of my friends who have come and gone in the last 6 months. For those of them who had been here a while the last few weeks were always a mixed bag of emotions and I have had the discussion with more than one person about what they will miss the most. For me there are so many things I know I will miss.

Being a girl who is often led by her stomach the food is going to be one of the things I miss the most. Idli for example, small fermented rice dumplings shaped something like flying saucers. When I first arrived I was really not too keen on them especially at breakfast time but now I absolutely love them. Served with Sambar (lentil curry) and coconut chutney there is no finer way to start the day. Dhosa, the savoury pancakes that are also often served for breakfast sometimes thin and crisp sometimes soft and light will also be something I will be sad to live without. Egg curry, Pongal (a sort of rice based thick porridge) chapatti, Raita, paisum (a bit like spiced rice pudding) the list of food that I will miss eating on a regular basis is a long one.

It is also worth me pointing out that it will not only be the food itself that I miss but our wonderful housekeeper and chef at the doctor’s hostel. As well as being skilled in the kitchen she is also just a truly lovely person. Always smiling and with this wonderful musical sing song laugh. She really looks after me and makes sure I eat well, and plenty! I think to be honest she has to at least partly share the blame for the slight pot belly I have developed. Here is an example. When I go out on my field visits she always packs me a tiffin box with lunch in it, Chapatti and some veg curry or egg. Earlier in the year we had a slight disagreement about this packed lunch. Well maybe disagreement is too strong a word. It was a negotiation and not one which my waistline did particularly well out of. I said that three chapattis for lunch was too many, I am only little I reasoned, surely three of the circular breads and a portion of curry was too much. She looked unconvinced but the next time she made me packed lunch I was pleased to note only two chapattis. I was content and assumed this was the matter sorted. However when I went to the field later that week she gave me a cheeky grin and said “two chapattis and one very small chapatti” true to her word on that occasion the third chapatti was petite but I knew at that point that I had lost the negotiation process. In subsequent packed lunches I have enjoyed three full size chapattis. She is a wonderful woman and like so many Indian matriarchs she is a force to be reckoned with. If she tells me to eat, I eat and it is always extremely tasty!

So you may well ask why in a piece of writing considering what I will miss I have chosen to talk to you about food and not for example my friends here. I go on about them all the time surely they will be what I miss most of all? Well actually I beg to differ. The people who I have met here and who I have shared my time with are amazing people, wonderful, intelligent, funny, kind and caring people. But I have no intention of missing them. Far from it my current plan is to keep in touch so well that I have no cause to miss them. Not just the people who remain here in India but also the people who have now moved on, be it to other areas of the country or back to their native lands. So if you are reading this and you fall into that category be warned, I have no intention of losing your friendship.

Well I feel this is enough chat for now. I am already planning my next dispatch from India! I want to tell you a little bit about the traditional medicine that we use to complement our practice here. It’s a topic that I find really rather interesting and if you fancy reading about it then please do join me next time folks!

Lots of love,

A x

With all this talk of food I figured I would treat you all to a photo of us cooking poori, most things taste good when deep fried and these bad boys are no exception.

I am rubber you are glue...

Hello there, this is just a super quick entry, and if I am honest just an excuse for me to show you a picture that I liked. Basically the driver who picked me up from the airport in Kerala as well as wanting to improve my tamil skills (we spent the whole journey practicing conversational tamil) was also really keen to share with me some of the more interesting sights along the journey. One of which was Rubber trees! So here it is a picture of real India Rubber being harvested from the tree. I hope you like it, I think its pretty cool!

Much love,

A x

Delhi Belly

So my month in the UK flew by in a bit of a flash, lots of frantic socialising and spending time with all you lovely people. However this is a blog about my adventures in India so the story picks up again as I return to that wonderful country of elephants, spices and monsoon rains.

I got my flight back to India on the 28^th, leaving Heathrow again I was excited at the prospect of seeing my Indian friends and I was looking forward to getting back into the routines of my life in the small Tamil Nadu town I think of as home. However I must admit that I was also filled with a slight trepidation.  Perhaps even more than a slight reluctance to leave my family again so soon and with certain things feeling unsettled and up in the air.

On arriving at the airport I was told that I had been upgraded to club class, I don’t know about you but I have never in my life before flown anything other than economy. Well I thought to myself, I might not be worry free but at least I am going back in some style! The flight was lovely but uneventful, my seat was more comfortable than most beds that I have slept in recently and I was out like a light for almost the entire trip. Now some of you may not know this but my primary destination on arriving in India was not the south! I know it is shocking to admit but I actually went to the north of India. Why I hear you chorus? Well actually it was for a obstetrics and gynaecology basic practical skills course held in Delhi.

Delhi in July, I can say with some confidence was the most sticky and humid place I have ever visited. It was very similar to that sensation of walking into a butterfly house or the glass houses in botanical gardens. The air is hot and wet. I arrived after 11pm and still there was not an inkling of cool breeze. The muggy night air enveloped me and I greeted India with a fresh gleam of sweat on my brow.

I was met at the airport by a really sweet driver who I had arranged via my hotel and despite having worried about being a female traveller alone in the big city I am very happy to report that in the two days and three nights that I was in Delhi I never once felt threatened. After a comfortable night in my hotel I headed off to the course. Unsure of how far the course venue was and how to get there I decided to take a taxi, not too expensive at only 250 Rupees and worth it as I was already running late. The driver I am again pleased to report was a lovely man and although he didn’t know any better than I did really where to find the training institute we muddled through and eventually got there. I only had 220 rupees in small notes on me or alternatively a 1000 rupee note. The driver looked at me a little concerned, obviously he had no change. I had agreed the price with his boss before getting in the taxi and I got the impression that if he went back without the full fare there might be trouble, but it is a testament to the trusting culture in India that he agreed to take the 220 rupees on the promise that if he came to my hotel that evening I would give him the balance.

The course itself was really good, nice to be learning again and meeting some lovely obstetrics and gynaecology doctors from all over India. I was as usual a bit of a novelty, being white and British. It is going to seem strange when I move back to the UK full time not to be considered exotic! As one of the course co-ordinators said to me I was their first example of course tourism.

I decided to take the Metro back after the course and I am sure I have said it before but I will certainly say it again, the Delhi metro is really rather wonderful. Cheap, safe and air conditioned it even has women only carriages for all those independent women. The only amusing thing is that to get into it you have to pass through something akin to airport security. Although I suppose in a country where terrorist attacks are a very real danger this is not such a surprise. My favourite sign at the entrance to the metro by a mile is the one explaining what you cannot bring with you. This includes, and I am being totally serious,  manure (of any kind), rags (including oily rags), Human remains and any decayed animal or vegetable matter. For some reason this just tickles me, especially the need to be so specific. As though there was a person in the queue who thought “well I know it says no rags but surely these oily rags are ok?”.

Anyway I made it back to my hotel safe and sound without transporting any manure at all (of any kind). I was just meandering through the streets wondering what to do next when I spied my driver from the morning. He looked happy to see me and was such a gentleman that I really had to be quite forceful in my encouragement before he would allow me to tip him the princely sum of 10 rupees.

All in all it was a very pleasant trip and after the two day course I packed myself up and headed back down south with a much improved opinion of them up north. It really is great to be back in India although as I hinted at earlier things back in England are a bit worrying at the moment (not a subject that I need to go into on this blog) so I might need to cut my stay a little shorter than anticipated. All the more reason in my opinion to write plenty while I am still here and make the most of it!

So to cut a long story extremely short expect more blogs from me in the short term, I will be attempting to capture it all in writing in shorter period of time. That is a lot of shorts in one sentence but there you have it!

With as always all my love and best wishes.

A x