CMC - Day Twenty (the final day)

On a narrow dirt trail that edged its way through neon green rice paddies, Jinu told us about a young women who lives in the house from which we'd just left, outside the village of Kamasamudram, pop. 1700. She had recently delivered a child at 33 weeks gestational age (of the expected 40) in the back seat of an auto-rickshaw en route to CHAD, the Community Health And Development hospital I've written about previously. The baby survived without complication, but his mother was still in the hospital, having suffered from post-partum hemorrhage and, later, disseminated intravascular coagulation (DIC), a very serious hematological response that can occur as a result of severe illness and that predisposes one to dying. Over the course of three weeks in the intensive care unit, she had stabilized. Jinu's purpose in visiting the house was to better assess their economic status, so the hospital would know how much, if any, they could pay of the enormous medical bill that they had recently issued.

I realized that these CHAD nursing visits to the villages that lie in the 88 village catchment area (I'd previously been told, and written, 69 villages) were about more than the ante- and post-natal visits that had occupied much of the morning, and would occupy much of the afternoon. The community nurses spend 5 days a week touring the villages, working with the assistance of "pitchus" (the part time community health workers) and hospital-trained health aids that oversee them, and to follow-up and prepare for the doctors visits that take place in each village once a month. Today, my last at CMC, we would visit eight villages, ranging in population from 1700 to 114.

Jinu, in her sky blue cotton sari, shielded herself from the bright sun with a black umbrella as she led our group of four to the next home, a mud-brick and thatch dwelling that we could see in the distance beyond a large banyan tree and a herd of contented cows. Behind her was the regional health aid, who assisted the pitchus of the 8 villages, and who wore her faded pink sari with a dignity that matched the severity of the tightly drawn skin of her aging face. Kevin, a very nice medical student from St. Louis, and I followed. The banyan tree was decorated with large cotton satchels hung from its branches and aerial roots. Inside them, we learned, were the placentas of a generation of cows, saved and displayed to increase the yield of the cow's milk that would feed not just the calves but the villagers.

We arrived at the mud home and stepped past the delicately drawn kollam, intricate chalk floor-drawings that sit at the entrance to, and serve to welcome the gods into, the home. A young women with a swollen belly sat on the front step in front of a darkened entrance, her face yellowed from the turmeric powder that I would see on women throughout the day, particularly the pregnant ones. Kevin told me the story of the Tamil prince who'd gone to China, fallen in love with a Chinese woman, and returned home with a new taste in skin color, to which generations of women that followed would aspire. The woman was 26 years old. Married at 16, she'd suffered through 10 years of infertility. Traditionally, women are expected to conceive within the first year of marriage, and I hoped quietly that she'd not been punished by her husband's family for a transgression that was not her fault. We were invited in to do the prenatal visit with Jinu, taking her blood pressure, measuring the height of her uterine fundus, listening for the fetal heart beat. As with several of the 20 or so that we would see throughout the day, we referred her to the hospital for further evaluation of edematous feet and a slightly elevated blood pressure, possible evidence of impending pre-eclampsia. Concerned for this precious child, I'm sure she won't hesitate to seek care.

In Mothakkal, a village of 200 people about 1km from the small country lane where we parked, we met a 25 year old torn between excitement at the birth of his son, a beautiful and healthy child, and worry for his 49 year old mother. Within the past few months she'd been diagnosed with chronic kidney failure as a result of long-standing high blood pressure. The hospital had recommended twice-weekly dialysis, which, at the cost of 5000 Rs per month, was beyond their ability to pay. Even if they could pay, the 2km walk to public transport was prohibitive in her frail state. She looked ill, fed up, exhausted. She will likely die soon. Outside of her clean, brightly painted mud hut a group of grandmothers sorted peanuts and shared gossip, both freshly harvested from the surrounding fields.

As the day wore on, we visited Mothupullam (pop. 900), Chinumothupullam (pop. 114), Kallamburam Kottai (pop. 370) and others. The sun started to fall in the west and we started our journey home, stopping at a busy rural junction for chai. A young boy delivered it from the chai-stand across the road from where we parked. We watched a family of monkeys play on its tin roof, some peering over the edge to stare at the men taking tea.

It was a wonderful final day at CMC, going out to see the village of the families and children that would hopefully stay out of the inpatient wards where I started my month. It was great for the same reason that all home visits are: you understand people's health in the greater context of their lives. You see the fields in which people work, the houses where they make and raise their children, and where they will likely spend their final days. Sometimes all of these things are taking place under the same roof at the same time.

Having been in Vellore for four weeks, some final thoughts are in order. Being in one place has made me think about the difference between living in a place and just visiting. One could easily say that I've just been a visitor here; that is of course true. However, I would suggest that visiting a place requires only a certain level of engagement, one that demands very little of the visitor. Just the other day i sat on a plastic bag on the side of a road as a man replaced the soles of a month-old pair of sandals (or chappals) that i'd already worn through. I made a phone call one day and felt cheated when the man told me to hang up and then demanded that i pay. I refused. He yelled. I yelled back. He slammed his fist on the desk. I stormed out. India taught me several years ago what it is to be angry, what it is to release that anger, and what it is to feel better having done so. Among the places i've traveled, India is unique in that it forces on to respond to the environment in a deeper way. It overloads the senses and waits for one's reply. It pushes one to extremes of rage so that one may know true peace. It forces one to step through filth in order to find its incredible beauty. It makes me feel as if i've lived here, if not now then sometime before, because there are few places in which i felt so alive.

All that said, i'm looking forward to coming home (and to coming back). Thanks for putting up with my daily emails. Knowing that some of you (mom) are reading these has made me look at every experience and every day a bit more closely. Experiences, like food, are better when shared; mine has been made more rich because of you.