A week of Weddings Part One

So the wedding season is in full swing and this week I have had the honour of being a guest at two very different weddings.

The first was the much anticipated wedding of one of the Indian doctors working in the Hospital here. He is a Catholic from Kerala and in January via many happy coincidences he was introduced to a very lovely girl from a very suitable family and they got on like the proverbial house on fire. This prompted much teasing from all of us of course as he was soon spending all evening, every evening on the phone getting to know her and after a short while planning the wedding. Forget Prince William, he really has not had a look in here in this corner of Tamil Nadu, the only wedding we were interested in was to take place on Monday 25^th of April in Cochin.

The invitations arrived amongst much excitement, well much excitement for me as this was the first formal wedding invite I had ever received. My outfit I was quite settled on, my favourite salwar kurta in orange and purple, the only concern in my eyes was what present to get the happy couple. I had big plans to find a nice gift while travelling in the North of India but for some reason nothing seemed quite right. My friend the American paediatrician and I were going to split the cost but what to get? Other friends had gone down the classic route of home wares, for example two of the guys had bought a very handsome electric kettle, but I was stumped. Eventually in true last minute style, once we had arrived in Cochin I decided upon a nice French press coffee maker from café coffee day and a pretty painted photo frame from fab india.

My little sister Harry is still in the country and because of various friend overlaps with the medical students and “oh what a small world” moments it was possible for her to come along to the wedding. Travelling down on the Sunday night meant that we all got a little much needed time to relax in beautiful fort Cochin together, friends from the charity, medical students and Harry and I. We wondered around in the ridiculous heat, thoroughly enjoying ourselves but unable to shake the slight feeling that we were in some sort of Butterfly house/ tropical botanical gardens. The air was wet and heavy and the instant you stepped outside there was a noticeable beading of sweat which would form across foreheads and top lips. Luckily we remembered some of the more chilled out hang out spots from our last visit. We had a delicious breakfast involving lots of fresh fruit at the Kashi Art Café and then after some light shopping we found our way on Harry’s recommendation to the Teapot café. If anyone is going to Cochin soon I suggest a nice cold glass of ginger sweet lime and a slice of cake. The high ceilings and relaxed atmosphere were exactly what we needed.

Fully refreshed we went to prepare ourselves for the wedding. Dressing in very elaborately embroidered salwar kurta for the ladies (yes we were a little overheated) and a strange combination of outfits for the menfolk we were with. This ranged from shirts and trousers to a Lungi worn by my lovely friend the American anthropology student. A lungi for those who don’t know (including me until recently) is the name for the traditional attire worn on the lower half by many Indian men, it consists of a length of cotton fabric wrapped around the waist and then either left to hang long down to the ankle or flipped up to create a shorter garment for coolness or ease of walking. That my friend wore this is perhaps testament to the fact that he has been in India too long, although as he pointed out it is pretty practical in the heat!

The wedding itself was in a large modern Catholic Church in Ernakulum and involved a lot of singing hymns along to what sounded suspiciously like Keyboard demos from the electric organ. The happy couple looked so ridiculously happy and well matched and although significant language barriers forbade me from actually understanding what was said it seemed to be a beautiful service. The reception was (thankfully) held in an air conditioned meeting hall nearby. It was such a relief to be somewhere cool by this point as I realised that my outfit in true Indian style had been dyed with dye that had no intention of staying on the cloth and with all the sweating I had started to go an interesting shade of purple. The reception had even more people present than the wedding itself and was a very jolly affair with everyone wandering about chatting and some pretty delicious Keralan food at the buffet counter. Before long the time had come for us to make our sleepy way homeward in the big minibus, back up into the mountains.

On eventually arriving back at the accommodation in the early hours on the morning I was a little surprised to see that my bedroom light was on. One of the medical students reminded me that on leaving there had been a power cut and I must have accidentally left the switch on. I also noticed that my window had blown open. A minor annoyance at any other time but unfortunately due to the thunder storms recently a rather epic problem. Let me explain. In spring and autumn, usually after a thunderstorm you will get termite swarms. Literally thousands of king and queen termites with wings take to the skies on one night. They happened to do this on the night I was out. Hundreds and hundreds of them attracted to the lights in my room had flown in and promptly shed their wings and started crawling around in my stuff. When I arrived home my bedroom looked like a cross between a horror movie and a biblical plague. I was stunned, I had had such a great time away but now my room was full of creepy crawlies! Unable to deal with it all on Monday night I just went to bed in a spare bed in another part of the house. When the housekeeper arrived the next day she bravely did battle with the insect hoard and I am relieved to say that my room is back to normal now.

This is a very long blog, I am tired of writing so I am certain you will be tired of reading it. I will stop here for now. Wedding fun, dying myself purple and having a plague of termites is as much as I can deal with right now. I will tell you about the second wedding in one week next time.

Lots of love.

A x

The boys looking dashing.

At the reception. 

 The Happy Couple.

The termite swarm!

Holiday snaps

So I made it back home to the Nilgiri hills after a wonderful and extremely tiring 2 week holiday with the family. As promised here are some photos! Izzy and Mick have some much better ones I am sure.

The trip starts here in the Nilgiris, but who are these dashing young people? and where is the boat that they are obviously dressed up to go sailing on?

 This is me all dressed up for my birthday party, at which we did our best as a group to consume 10 litres of ice cream and 3kg of bananas...

 We then made the journey to Hampi by taxi then night train. Here are a couple found loitering in the banana plantations by the Mango Tree restaurant.

 This is a very large Ganesh as found in Hampi, with a very small Izzy next to it.

This is the view from sunset point in Hampi, at sunset obviously.

 Izzy in one of the Temples of Hampi.

 Beautiful wall painting and beautiful sisters at the Amber Palace in Jaipur.

 Spotted this marching band in Jaipur, they were really keen to have a photo taken.

 This is a painted elephant, obligatory in any Indian holiday photo selection.

 We got a night train to Jaiselmer and Izzy hooked up with some colourful characters..

 This Rajastani city is blue so it must be Jodhpur.

 This is the one photo I took of the Taj Mahal before my camera battery died.

All in all it was a pretty amazing whirlwind tour of the north. It was great to see the Knowles lot although we obviously missed Joe and Jane. Back in the hospital now which is great, it was only two weeks but I missed the place! I will write again soon and I hope you like the holiday pics!

Lots of love,

A x

Travellers

Hi there. This is going to be a short update of what I have been doing, sent from a little internet room in Jaiselmer fort. Since I last updated my blog a few things have happened: The Knowles family have descended upon the Indian subcontinent, I have turned 27 years of age and we have travelled goodness knows how many miles by road, rail and air.

My rather large and wonderfully loud family arrived just over a week ago and the first point of call was my home town here in India. I showed them around with thinly masked pride at how lovely my every day surroundings are and introduced them to all the wonderful people I have met in the past 2 months. Then on the 4th of April myself and one of the teachers at the school had a joint birthday celebration. A lovely afternoon ice cream party in the garden of the big and beautiful house where the Indian couple who run the hospital live. It was a really lovely afternoon and I am deeply grateful to everyone at home in England and at home in India who made it such a special event. I was bowled over that some of my friends in the UK had gone to the effort of sending me cards and presents, I am a ridiculously lucky person to have such people in my life! I was also very touched by the messages online which I received, all I can say is thank you many times over. So far being 27 has been great and I stil have plenty of 27 left to enjoy!

The day after the party, on my birthday itself we set off on our travels. It is safe to say that we have barely had a spare moment since! The itinerary has included seeing temples in Hampi, a beautiful Fort in Amber near Jaipur, the observatory and markets in Jaipur itself, the huge desert sand castle that is Jaiselmer and experiencing many othe sights and smells along the way. I will upload some photos when I am back in the comfort and civilisation of my little hospital in the south and you can see some of the beautiful and strange things we have experienced.

This is all I really have time for folks but like I said I will be flooding you with holiday pics some time soon. Don't say I didn't warn you!

Lots and lots of love,
A x

Louder than Words

Vanakkam, hello and welcome to another few snippets of life here on the Indian subcontinent. March is almost at an end and that marks two months of my time here already over. I am being sent beautiful photos of the British springtime which I am missing out on and the air here in my little corner of the Nilgiri Hills is getting warmer by the day. The seasons are on the change! With all the movement of people this week has gone by in a flurry. Also today is exam day for our nurses who are getting their formal qualifications. It’s all go!

The most memorable case in the last week as far as I am concerned is a patient who I saw last Thursday. With my rather ropey Tamil I ascertained that she had been suffering from abdominal pain for the past 3 days, no diarrhoea, vomiting or pain on urination associated with it, and that she was currently having her period which was heavier than usual. Knowing the high pain threshold of my tribal patients and not wanting to miss anything I asked one of the Indian doctors to check my version of events with the patient, could this just be very bad period pain? It seemed unlikely that this woman would have travelled to the hospital just for that. My Indian colleague managed to gain an extra few pieces of info. This patient had previously had a sterilisation procedure (tube tie) and before her current period she had missed one month. The question was there; could this be an ectopic pregnancy? Although our hospital doesn’t have enough money to stock urine dip pregnancy tests we do have an ultrasound scanner. The doctor who spoke to our patient has had training in obstetric ultrasound so she had a look. There it was, right next to the left ovary what looked like it could be an ectopic. Although interestingly the majority of her pain and tenderness was on the right side and we couldn’t exclude appendicitis. The senior staff decided we had no choice but to take her to the operating theatre as an emergency. Under a spinal anaesthetic it was possible to do an open operation to see what was going on. The senior obstetrician/gynaecologist and her husband the senior surgeon both scrubbed for the procedure. The woman was extremely slim so finding the relevant anatomy was not difficult but on closer inspection the fluid filled sack attached to the left ovary was nothing more alarming than a small cyst with a little blood in it. This is known as a haemorrhagic cyst, not usually anything to worry about. We still needed to find the culprit when it came to diagnosing her pain. After a brief rummage with the intestines we found it, a rather angry looking appendix! So there you have it, not an ectopic after all but appendicitis.

What really struck me about the proceedings was the way the patient dealt with everything. These women are so brave, having lived their whole lives in the tribal villages to make the journey to the hospital and put their faith in the care of the doctors here when it is so different from their previous sphere of experience.  Before the operation you could read in her face how scared she must have been. After the spinal anaesthetic, although she was fully awake she could feel no pain from the operation and she started to relax a little. I was not needed to scrub in for the operation so I busied myself preparing things and trying to be useful, I had time to regularly check on how she was getting on. Manually checking her blood pressure and changing the warmed bottles of intravenous fluid. This gave me the opportunity to hold her hand and say some reassuring words in my broken Tamil. Every time I went to check up on her she would give me this huge grin, I couldn’t believe that there she was in this amazingly stressful situation smiling at me.

Post operatively when I went to check up on her again and on the ward rounds before her discharge yesterday she gave me the same wonderfully warm smile. I feel like as well as learning Tamil I am also learning another language, one which I have always known but now need to rely on so much more, a method of non-verbal communication. I use it much more consciously now than I ever did in the UK where I could just say what I was thinking.

Another place where non-verbal communication has become vital to me is the delivery room. While the nurses are sitting their exams this has jokingly referred to as my department. On Monday and Tuesday we had 5 difficult and complicated obstetric cases and I was sitting in the labour ward all day and well into the night monitoring them. I am very proud to say that I delivered four of them, the fifth needed a caesarean section. Developing a relationship with your patient when you cannot make small talk is a very different experience. I find that I am constantly learning to pick up cues as to when the women need their hand held, their brow mopped or their back rubbed and when they need time to themselves to rest.

You can probably tell that I have been busy in the hospital this week as my writing is more clinically orientated. The Knowles family clan are arriving in two days and I will be taking a break from my hospital duty so I have been feeling even more inclined to make the most of my experience before the holiday starts. We will be travelling to the North of India which is both exciting and a little scary for me, a journey into the unknown! Anyway I will try and keep up with my blog and let you know about the travels etc.

In the meantime lots of love and hopefully hear from you soon.

A x

P.S. I thought this would be very boring without any pictures so here is one of the very cute and super destructive toddler who lives in the hospital, (its a long story).

Measles and Moonlight

Hello again. I hope this posting finds you well and enjoying life wherever you may be. Things are generally speaking rather good from my viewpoint. The newness of being in a foreign land is starting to wear off and I have found myself on certain occasions referring to my little nest here among the mountains as home. This is in many parts thanks to the wonderful company of my friends and colleagues here at the hospital and in my wider community. The charity here seems to attract a certain type of person. That is not to suggest in any way that the personalities or outside appearances of members of the team are in any way generic but rather that in their own way they all share a passion, a certain keen desire to help people and also to understand their world better.

There are men and women of all ages and religions from all across India and indeed the globe. All here to try and understand the culture of the tribal population and best help them to become a community which is balanced. Strong and independent, aware of its own special heritage but also able to survive and even integrate into modern India. I wish I could introduce you to all the wonderful people who I have been lucky enough to meet while here. One of the interesting aspects of living here is the constant ebb and flow of people around me.

One person who is leaving soon is the young,  pre-medschool, American research student who I am sure I have spoken about before. She arrived a week or two after I did and we have become firm friends. I can’t deny that her leaving to return to America for med school entrance exams is anything other than sad for me. She is a very, very funny person with a sense of humour which ranges from bone dry to ridiculously silly and I have enjoyed being swept up in the slight whirlwind she creates. She will however be returning in the rainy season (all related to her project which involves leeches, gross huh?) which will be something to look forward to. Also coming to the end of her annual visit is the lovely northern retired midwifery teacher. I will certainly miss her as a companion and sounding board. She combines two vitally important aspects for a good friend, firstly she is a brilliant listener and being somewhat further along life’s journey than I am she dispenses sound advice built on experience. Secondly being British she is always willing to sit with me for a cup of tea!

As I said people here come and go. A new arrival to our group (although she is a regular visitor) is a retired paediatric professor from Kerala. Despite being a little older than most of us she is as sharp as a pin and a brilliant clinician. She is also very fun to be around and had been with us barely more than a few days when she arranged a very sociable Sunday cook off. We all enjoyed the shopping and talking and cooking and eating and I am glad that she will be with us at least until April. It is also brilliant to see her working with the other visiting paediatrician who is an American from a Tamil family. It is inspiring to see them discussing child health and it seems that working together they have a chance to really achieve great things to help the malnourished children here.

In a rather dramatic turn of events this week one of our number got taken rather seriously ill. The American anthropology research student, here on an international scholarship since August last year came down with a fever. Illness being not uncommon in India he didn’t think much of it until day five when he was still burning up and started to develop a rash and a hacking cough. I must admit he scared me quite a bit when he phoned me in the evening to “just ask a bit of doctor advice” and proceeded to tell me he was finding it very difficult to breathe. My expert medical advice was for him to come in to the hospital pretty quick sharpish! The junior doctor on call and I gave him the once over and decided that although we were not sure exactly what was wrong with him it was probably viral and he should stay at the doctors hostel for observation, paracetamol, plenty of fluids and antibiotics to prevent secondary infection. The next morning we got a lot of senior opinions, the doctor who runs the hospital and two senior paediatricians who are visiting. The general consensus was that it may well be measles and he was admitted to the hospital for a day and overnight. Thankfully after a lot of sleep and paracetamol he seems to be looking a lot better today and the exanthema is starting to clear.

I will write again soon because there is probably lots more news for me to bore you with and I do want to show you some of the pictures that I have been taking. Obviously lots of these photos focus quite heavily on the massive moon that we have all been experiencing. It has been really amazing to behold. Dangling over the mountains without any light pollution to interfere, all of us have found ourselves doing a lot of gazing upwards the past few nights. Last night on one of these household moon gazing events we were surprised to hear that we were not the only creatures to be in the immediate locality. A very strange and rather abrasive noise announced the arrival of barking deer in front of our porch. For those of you who are unaware barking deer look a lot like deer, make a barking noise a bit like a dog and according to a friend of mine who is interested in such things have recently been reclassified into the goat family, you learn something new every day!

So from measles to moonlight with a promise of pictures to follow and that is where I will leave you for now. As always lots of love and thanks for the messages I have received.

A x

p.s.
so yesterday my internet was not working so I didn't upload this, so here it is today instead complete with pictures.

Blue Moon

Sunset

Chestnut headed Bee eaters

Strange fruit

In this week’s missive I want to tell you a few anecdotes about fruit. So to start us off here is a little Tamil related introduction. In Tamil the word for fruit is Parlam, with the “rl” sound made by touching the tip of your tongue at the back of your hard palate and letting it roll forward. As a previous strict Anglophone this is not an entirely easy noise for me to create. I must admit that I have developed a strange habit recently, when I see something that I know the Tamil word for I tend to rehearse it to myself in a repetitive fashion. This is why if you were to walk next to me on the street as I passed one of the numerous fruit stalls in town you would hear me muttering “Parlam, parlam, parlam, parlam”. This is one of the many reasons people look at me funny.

During one of my mobile clinic visits about ten days ago we went through a village inside the nature reserve. We did our usual thing of weighing the babies to check for malnutrition and consulting with the patients who have chronic disease to stock up their medications. As we walked past one tree I noticed some large green fruits, they looked like citrus fruit but I was unsure of what variety. I asked one of the community health workers with us what the name of the fruit was. She didn’t know the English name for the fruit but promptly enlisted one of the local tribal men to climb the tree and retrieve one of the fruit for me to eat. I tried to explain that this really would not be necessary but by then he was already clambering along one of the higher branches. With the man and the fruit both safely back on solid ground I cut through the waxy skin to discover that it was in fact a grapefruit, not quite ripe but very tasty and refreshing on a hot day. This was one of the many times that I have been grateful to have my Swiss army knife with me. It came in very handy carving the fruit into segments to share with everyone. 

This could have been the end of the story but a few days ago we went to a different village, deep inside a tea plantation. Just to the left of the village temple was a large and majestic tree with some familiar looking fruit on it. The same health worker was with us and she immediately decided that I obviously was in desperate need of grapefruit. She called for a young boy in one of the houses and before I could say anything I heard her say quite distinctly in Tamil that the English doctor wanted some of the fruit. I tried to say that really I was fine, the tree was very tall and the boy was quite small and I really didn’t want to have to explain to any family members how their child broke a limb fetching me fruit! But in the blink of an eye the boy was up the tree and three soft thuds announced the arrival of some very tasty looking pink grapefruits. In exchange for his skilful climbing the little boy got to keep one of the fruits (it was roughly the size of his head). My Swiss army knife was pressed into action again dividing one of the fruits between those of us working and the third fruit was sent home with one of the health workers for her family. All in all a good outcome with no fractured bones!

In addition to fruit that is recognisable from English supermarket aisles (apples, bananas, citrus fruit and now the first fruits of the mango season) I have come across some entirely new fruits here in India. One which seems freely available at the moment is Chikku. This soft, round, brown fruit has a rough exterior something like sandpaper. The flesh inside is grainy with a texture not unlike a ripe pear and a taste which is sweet and very rich. There are four seeds which look like large apple pips. I really like the Chikku fruit, which is good because if the cheap price in the market is anything to go by I am fairly sure that it is both local and in season.

Another Indian fruit which is new to me is the Nungu. I was introduced to this fruit while on a field visit to a tribal village. The jeep stopped by the side of the road where a man was stood surrounded by cannonball sized dark fruit. The tribal health workers were thrilled to see it and I get the impression that this is a fruit less readily available on the local stalls. The fruit seller took his large curved knife and hacked into the thick husk separating three jelly like segments. He repeated this a few times, each time with me trying not to wince too badly as the sharp blade came down right next to his unprotected fingers! Soon we had a bag full of the fruit segments to taste. It is very difficult to adequately describe the taste and texture of Nungu. I would say the outside of the segment has a texture a bit like lychee but with a much more delicate flavour. In the middle of each segment there is a pool of liquid which is very refreshing and tastes a little like the water from a tender coconut, not surprising as I have been told the fruit is a relative of the coconut itself. I will post a picture of the fruit seller on the roadside when I get a minute.

Pictures as promised.

Wow this is a very long post about fruit, perhaps I should make more of an effort to write about my work in the hospital next time? Just to reassure you I am still working and learning new things every day about medicine in rural communities and tropical climates. I am getting plenty of experience in the outpatients department, working in the field and in the last week I have been spending more time in the Labour ward which I am enjoying a lot.

Again I want to thank people for keeping me updated with goings on it the UK. Six weeks in and I must admit I am getting homesick. Lots of love to all and hopefully catch up soon.

A x

King of the road

So last week I certainly did not let the grass grow under my feet here in India. I was out every day in the field, the Mobile Clinic and the Area Centres. Many many bumpy Jeep rides and beautiful views of the scenery! So as a result I was very very tired!! The travel and the heat of the sun combined with trying to converse in my extremely poor excuse for Tamil has worn me out.

Therefore you will not be getting my usual long monologue, (please try and hide your relief at this news). Instead using the magic of photography I will try and convey my adventures to you. As they say a picture speaks 1000 words.

The river where they wash Elephants in the nature reserve. There are 3 tribal villages nearby.

One of the new area centres where we have outreach clinics.

A lizard, put in for no reason other than it was a cool lizard.

Walking to a rural village

Still walking....

Tribal house.

Tea plantations

O.K. well you asked for more pictures so this is what you get!! I will try and write more next time when I have recovered from the travelling.

Love to you all,

A x