Today was full of physical exam findings. I was surprised, in examining a young child with bronchial pneumonia, as he squirmed and screamed in his bed, six finger on each hand, six toes on each foot - polydactyly we call it - and a rather less exciting pneumonia. I peered into the eyes of a young boy who'd gone suddenly blind, his edematous optic discs in focus through my fundoscope. I heard shifting dullness to percussion on a child with an pulmonary empyema. Cafe-au-lait spots, sacral dimples and super-sized tonsils. And then a rather symbolic case: isolated dextrocardia. Literally, a child with nothing more than his heart in the right place.
It's Valentine's Day, India's new favorite holiday and one that i cherish. The papers are full of advertisements for romantic candle-lit dinners in Chennai's most expensive restaurants. It's "Hickey Night" at the Taj hotel's Veranda restaurant: "It's that time when love fills the air. When candle lights and roses are standard decor. When diamond rings and men on knees are common. When cosy couples exchange sweet nothings, glances and kisses. And when Hickeys become sweet memories." Again, the changing face (or neck) of Indian love stories. One article acknowledges the love that "blossoms" at college canteens. "College canteens have always been a place where teens find time to catch a glimpse of their crush. According to college student Samyukta Ramani, the atmosphere in canteens is very casual and the area outside is even better. 'By sharing food it symbolizes that you can actually trust someone [I couldn't agree more]. So especially if the member of the opposite sex wants to share food with you, we feel that it shows that they feel that little extra for us.'" The Chennai Chronicle covers the growing, though historic, trend of using charms, gemstones and feng shui to improve their love lives. Ashmita Shah, a young Indian executive, has taken to wearing a silver pendant: "I'm quite fed up with my friends trying to fix me up with some guy or the other so I thought that it would be a good idea to wear a love charm around my neck. Somebody told me that this would accelerate my love life so I decided to give it a shot." A young Indian banker overcame his disbelief when "a friend of mine wore this (Voodoo love amulet) and within a couple of weeks he met the girl of his dreams." Superstition is alive and well, and the article points to hollywood for the renewal of this ancient trend, specifically Jessica Simpson, "who began wearing a rooster around her neck as a symbolic gesture for her current lack of love life." Despite the ringing endorsement by feng shui experts and gemologists, how frightening is it that the youth of India (or of anywhere for that matter) might look to a group of people, celebrities, who couldn't make a relationship last if their careers depended on it?
I prefer the old Indian love stories, filled as they are with the kind of love that could move mountains. Flora Annie Steel has retold the Kashmiri story of Gwashbrari and Westarwan.*
"Ages ago, when the world was young and the mountains had just reared their head to the heavens, Westarwan was the highest peak in all of Kashmir. Far away in the west Nanga Parbat stood where it stands now, but its snowy cap only reached to Westarwan's shoulder, while Haramukh looked but a dwarf beside the giant king. But if Westarwan was the tallest, Gwashbrari was the most beautiful of mountains. Away in the northeast, she glinted and glittered with her sea-green emeral glaciers, and Westarwan gazed and gazed at her loveliness till he fell in love with the beautiful Gwashbrari; but her heart was full of envy, and she thought of nothing but how she might humble the pride of the mighty king that reared hsi head so high above the rest of the world. At last the fire of love grew so hot in Westarwan's heart that he put aside his pride and called aloud to Gwashbrari, 'O beautiful far-away mountain, kiss me, or I die.'
"But Gwashbrari answered craftily, 'How can i kiss you, O Proud King, when you hold your head so high? Even if I could stand beside you my lips would not reach your lips, and behold how many miles of hill and dale lie between us.'
"But still Westarwan pleaded for a kiss, till Gwashbrari smiled, and said, 'Those above must stoop, Sir King. If you would have a kiss forget your pride, reach that long length of yours towards me, and I will bend to kiss you.'
"Then Westarwan, stretching one great limb over the vale of Kashmir, reached over hill and dale to Gwashbrari's feet, but the glacier-hearted queen held her flashing head higher than ever, and laughed, saying: 'Love humbles all.'
"And this is why Westarwan lies for ever stretched out over hill and dale, till he rests his head on Gwashbrari's feet."
There is nothing more romantic, more saturated in superfluousness, than an Indian love story. Their ancestral connection to the great Hindu mythologies provides no greater wellspring of torrential and tragic romances. One of the great Indian epics, the Ramayana**, tells us of a divine love between Rama, the great bowman, and Sita, who's beauty knew no equal. As Rama entered the great city where Sita's father, King Janaka, reigned, he spotted one, "fair as Lakshmi, the very picture of love ineffable..." She saw him as well. They pined for each other that night, unaware as they were that the next day they would be married:
'O cruel night,' Sita said, 'who will kill a weakling treacherously? Let the sun but rise and my lord will be gone!
'O mind of mind, eagerly would you go with that dark sun, and with him return. You, who have been so long with me, can you stay just one day more?
'O moon, why do you wish to torture me, an innocent waning day by day, with your beams, a sharp lance burning like the hot sun?
'O south wind, cool and fragrant, though not to me! Why are you, with your hot breath and moon-beam fangs, prowling for my life like a tiger in a cave?
'Why does a warrior of rain-cloud hue roam the street night and day, trailing an unwed girl? Does this become a prince well-bred?
'If that cruel man, dark and wicked, won't come to me, would it be proper for me to seek him? Is this night a black sea, shoreless and lasting aeons?
'The songs don't stop, the day doesn't dawn; thoughts don't flee, night doesn't end; heartache lasts, life doesn't leave; and eyes don't close - O what a fate?
'Tell me, Sea, are you too a maiden cowed down by Madan's killing shafts? Your bangles loose, body weary, now up, now down, are you too a stranger to sleep?'
While thus she spoke distracted, tired and distressed but in virtue firm, let us tell what went through the mind of the spotless one that night in his palace.
'I saw her but once and my boundless love drew with my eyes her picture in my heart. I saw her again, but have yet to see the fullness of her beaty. Who can grasp the lightning?
'O moon, love's embryo, manure, seed and fruit, all in one, what have you done? Are you incapable of helping one who is helpless and alone?
'The night has spread like the dark eyes of the one who has taken possession of me, squeezing my very life out of me. It won't grow less, like the shame of aman who deserts his lord in the field of battle to save his life.
'My mind! You who have gone with that gazelle, have you lost all memory of me? Is it that you don't think of me, or is the distance too great for you? Or is it that you will not bid goodbye to one who care not to ask who you are?
'That poison is only to be found in the fangs of snakes whose eyes spit fire is an ancient story. In my case, it is in the soft glance of one forever embedded in my eyes and heart.
'When there are so many mountains, flowery lakes and groves around, why should a honey-tongued, bright-tressed woman choose my heart for her playground?'
Kiran Desai's The Inheritance of Loss is a newer, more complex Indian tale that won the 2006 Man Booker Prize. A young girl, Sai, who lost her parents to the Russian space program and who falls in love with her Nepali tutor, thinks about that sentiment's origin: "Romantically she decided that love must surely reside in the gap between desire and fulfillment, in the lack, not the contentment. Love was the ache, the anticipation, the retreat, everything around it but the emotion itself."
I find this statement about love so meaningful in its abstraction.
Thank you for indulging me today (and every other day). I get a bit carried away on Valentine's Day and wrote too much, perhaps. Ah well, today is a day to go above and beyond for those that you love. Do something romantic today.
justin
*From 'Folklore from Kashmir' by F.A. Steel with notes by Lt. R.C. Temple. The Indian Antiquary Vol. XI, 1882 and copied from Classical Indian Love Stories and Lyrics, Ruskin Bond (Ed.)
**The Kamba Ramayana. Penguin Books India. 2002
Saturday, March 24, 2007
CMC - Day Twelve
Ascending the numerical ladder of departmental divisions I started this morning my one week with Child Health III. This team, headed by the departmental chair, Dr. Prabakhar Moses, focuses on general pediatrics and asthma. Today is their clinic day and so i spent most of the day sitting on a stool next to Dr. Prabakhar as children were paraded before us with this and that typical complaint: fevers, wheezes, and rashes, oh my! For the most part, Dr. Prabakhar, as the senior physician on the team, sees the private patients, i.e., those willing to pay more for the privelage of being seen by the most experienced eyes. I saw for the first time Indian children in western diapers. Most children of diaper-wearing age come to us with a string around the waste, to ward off evil spirits, and a bottom and front liberated from the constraints of western waste management. If they pee or poop, what cannot be contained goes everywhere. So be it. Mother's change clothes, or, perhaps, invert their saris and life goes on. No cloth diapers to wash. No plastic diapers to buy. I'm told that as a consequence of this arrangment, parents become more in tune with when a child is likely to go and children are more quickly potty trained. This makes sense. In fact, before i left i saw a report on TV talking about parents starting to potty train their babies as early as 6 months, or before, simply by learning to understand better the baby's tells, if you will. They learn to know when the baby is bluffing and when he's gonna lay down a straight flush.
I witnessed today that overprotective parents are everywhere, particularly if they have only one child to protect. Little Suraj, 6 years old, came in with a distant history of febrile seizures. In the past week he'd had temperatures faithfully recorded as follows: 98.2, 98.5, 97.9, 98.6, 98.8 and all the way up to 99.5. Of course they gave two teaspoons of triaminic with every recording. I nearly laughed out loud. He read them off as if the child was on a pyrectic path to an early grave. All the while, happy little Suraj sat in his hot pink shirt quietly listening to the proceeding. "Do you have any other concerns?" Dr. Prabakhar asked. "Yes, sir." His teacher says he had difficulty concentrating in school. He's always up out of his desk, being loud, playing with others. He's not studying well at home." I looked at his chart to confirm that the child was still 6 years old. Yep. Other concerns? "Yes, sir. Do you think it's possible he could have TB?" Huh?! Suraj's father was the owner of a guest house for CMC patients and had occasional guests being treated for TB. Suraj liked to play with the guests. "Well, i suppose it's possible..." Anything's possible. "We can do a Mantoux," the very sensitive skin test used to identify TB antibodies. So this child left with the prescription for another bottle of Triaminic, a slip for a trip to room 8 (the procedure room) for placement of the Mantoux, a referal to a child psychiatrist, and my sympathies for being so precious.
As the morning progressed, and the caffiene from my break-time coffee wore off, i started to daydream of the various characters, most of them beggars, that I see on my way to and from the hospital. There's the child who always seems to find me just after lunch and follows me to the hospital gate, tugging at my trousers, his other hand held out in a cup, which he would bring towards his face in a gesture of feeding. He is chatty and smily as he tugs away, sent by his mother who watches from across the street. And yet, as i reach the gate of the hospital, with its baton weilding guard dressed in blues, the boy his gone. There is the man who sits on the Gandhi road near the paper (bike) stand and holds out his half fingers, the tips taken by leprosy. He has a salt and pepper beard, grown wild and long, and a kind face. Occasionally i drop a rupee in the remains of his hand. There seem to be a gang of wrinkled and short old women who hold out their hands and make the same gesture as the child, moaning and gesturing louder and faster when a white face goes by. "Baba, baba," and as i pass, "BABA!!" Baba means father and is a term of respect and endearment. I wonder every day why the color of my skin makes them blind to my youth. That one becomes "father", respected, because of circumstances out of one's control is unsettling. I pass them by. There's a boy i see occasionally who has, in place of legs, a small wooden board with wheels, that he pushes along. His outstretched hand is accompanied by the biggest grin. In contrast to the old women, he doesn't ask for pity, only money. He says with his eyes: "Check this out. Bad luck, eh? Can you help a brother out?" And i do. There are those that do not beg. One women i see every day, her hair matted into brown, dusty discs that hang suspended unevenly aside her ageless face. She dresses in once bright rags now the colour of dust. Her lips are the brightest red, not from lipstick, but from skin condition that i cannot identify. She looks, with her blank look, alternatively, lost and knowing. She take five steps one directions. Stops. Turns around and walks ten in the other direction. Stops. What can she be thinking? A man who could be her brother wanders the streets in a similar manner, asking nothing of anyone, just observing, actively. I wonder how they survive. There are times when there trajectory seems sure to collide with mine, when i expect an outstretched hand, and when i get not even a look, as these ghosts of the street blow by, inches away.
It's difficult to know how to respond to the beggars that are such a feature of daily Indian life. Do you refuse money to all, on the principle that reinforcing their begging only makes them more dependent? Some do. I have my own policy: I'll put aside a few rupees a day to give to those who seem truly in need and ask not just of me, but of everyone, including Indians. Those that single out westerners on account of the color of their skin will remain off my payroll. Each of us has to make our own rules, to find our own balance in a world where abject poverty abuts obvious, if only relative, wealth.
There is an old man who sits at the tea shop of my favorite chai wallah, and the young boy that accompanies him. He sports a trim goatee, a faded green and blue plaid dhoti, a white cast on his leg, and a look of sorrow. The first time i met him i offered to buy him a tea. At first he refused; then he accepted. He didn't thank me at the time and that really didn't matter. I saw him a few days later, sitting on a stone step, and he reached out his hand to me, asking for a cigarette. I indicated that i had none. Then he made a cup of his hand and waved it up and down towards his face. He was asking me for money. I indicated that i had none and continued on. I couldn't help but feel a little disappointed. It seemed so, i don't know...ungrateful...cheeky. A few steps on I chuckled to myself. Their are things about the economics of an Indian street that i will never understand and that this community of urchins and beggars probably wish they didn't have to.
Funny the contrast between the wealthy getting all the care they don't need and the poor getting none of the care that they do. Medicine - its infrastructure and practitioners - needs to reach out into the community, to help people like these. From inside the high walls of CMC, and many other hospitals around the world, you can't even see them.
justin
I witnessed today that overprotective parents are everywhere, particularly if they have only one child to protect. Little Suraj, 6 years old, came in with a distant history of febrile seizures. In the past week he'd had temperatures faithfully recorded as follows: 98.2, 98.5, 97.9, 98.6, 98.8 and all the way up to 99.5. Of course they gave two teaspoons of triaminic with every recording. I nearly laughed out loud. He read them off as if the child was on a pyrectic path to an early grave. All the while, happy little Suraj sat in his hot pink shirt quietly listening to the proceeding. "Do you have any other concerns?" Dr. Prabakhar asked. "Yes, sir." His teacher says he had difficulty concentrating in school. He's always up out of his desk, being loud, playing with others. He's not studying well at home." I looked at his chart to confirm that the child was still 6 years old. Yep. Other concerns? "Yes, sir. Do you think it's possible he could have TB?" Huh?! Suraj's father was the owner of a guest house for CMC patients and had occasional guests being treated for TB. Suraj liked to play with the guests. "Well, i suppose it's possible..." Anything's possible. "We can do a Mantoux," the very sensitive skin test used to identify TB antibodies. So this child left with the prescription for another bottle of Triaminic, a slip for a trip to room 8 (the procedure room) for placement of the Mantoux, a referal to a child psychiatrist, and my sympathies for being so precious.
As the morning progressed, and the caffiene from my break-time coffee wore off, i started to daydream of the various characters, most of them beggars, that I see on my way to and from the hospital. There's the child who always seems to find me just after lunch and follows me to the hospital gate, tugging at my trousers, his other hand held out in a cup, which he would bring towards his face in a gesture of feeding. He is chatty and smily as he tugs away, sent by his mother who watches from across the street. And yet, as i reach the gate of the hospital, with its baton weilding guard dressed in blues, the boy his gone. There is the man who sits on the Gandhi road near the paper (bike) stand and holds out his half fingers, the tips taken by leprosy. He has a salt and pepper beard, grown wild and long, and a kind face. Occasionally i drop a rupee in the remains of his hand. There seem to be a gang of wrinkled and short old women who hold out their hands and make the same gesture as the child, moaning and gesturing louder and faster when a white face goes by. "Baba, baba," and as i pass, "BABA!!" Baba means father and is a term of respect and endearment. I wonder every day why the color of my skin makes them blind to my youth. That one becomes "father", respected, because of circumstances out of one's control is unsettling. I pass them by. There's a boy i see occasionally who has, in place of legs, a small wooden board with wheels, that he pushes along. His outstretched hand is accompanied by the biggest grin. In contrast to the old women, he doesn't ask for pity, only money. He says with his eyes: "Check this out. Bad luck, eh? Can you help a brother out?" And i do. There are those that do not beg. One women i see every day, her hair matted into brown, dusty discs that hang suspended unevenly aside her ageless face. She dresses in once bright rags now the colour of dust. Her lips are the brightest red, not from lipstick, but from skin condition that i cannot identify. She looks, with her blank look, alternatively, lost and knowing. She take five steps one directions. Stops. Turns around and walks ten in the other direction. Stops. What can she be thinking? A man who could be her brother wanders the streets in a similar manner, asking nothing of anyone, just observing, actively. I wonder how they survive. There are times when there trajectory seems sure to collide with mine, when i expect an outstretched hand, and when i get not even a look, as these ghosts of the street blow by, inches away.
It's difficult to know how to respond to the beggars that are such a feature of daily Indian life. Do you refuse money to all, on the principle that reinforcing their begging only makes them more dependent? Some do. I have my own policy: I'll put aside a few rupees a day to give to those who seem truly in need and ask not just of me, but of everyone, including Indians. Those that single out westerners on account of the color of their skin will remain off my payroll. Each of us has to make our own rules, to find our own balance in a world where abject poverty abuts obvious, if only relative, wealth.
There is an old man who sits at the tea shop of my favorite chai wallah, and the young boy that accompanies him. He sports a trim goatee, a faded green and blue plaid dhoti, a white cast on his leg, and a look of sorrow. The first time i met him i offered to buy him a tea. At first he refused; then he accepted. He didn't thank me at the time and that really didn't matter. I saw him a few days later, sitting on a stone step, and he reached out his hand to me, asking for a cigarette. I indicated that i had none. Then he made a cup of his hand and waved it up and down towards his face. He was asking me for money. I indicated that i had none and continued on. I couldn't help but feel a little disappointed. It seemed so, i don't know...ungrateful...cheeky. A few steps on I chuckled to myself. Their are things about the economics of an Indian street that i will never understand and that this community of urchins and beggars probably wish they didn't have to.
Funny the contrast between the wealthy getting all the care they don't need and the poor getting none of the care that they do. Medicine - its infrastructure and practitioners - needs to reach out into the community, to help people like these. From inside the high walls of CMC, and many other hospitals around the world, you can't even see them.
justin
CMC - Day Eleven
The closest i got to a warm flaky croissant this weekend was a warm flaky baguette and i savoured every bite of it. Along side was a cappucino with a happy face of white frothy cream on a background of chocolate powder. I wish i could say that the happy face was due to the French influence but i don't think the French would go for such outward displays of frivolity. A pout maybe (eh Vincent?). Pondicherry itself is a relatively clean, relatively green Indian city with broad, tree-lined streets layed out in a grid. The signs read in French and Tamil and the names of the streets are often a mixture of the two: Rue Nandhiyavattan, for example. The Indian gendarmes guide traffic and guard the governer's mansion in white pressed uniforms and funny multicoloured hats. Children and adults play in large green park. Pondy, as it's known, is a pleasant city to which i could imagine returning.
My guesthouse for the weekend was in the beachside community of Auro Beach, 6km north of Pondicherry, and part of the large international planned community of Auroville. This community of some 1700 people from over 35 countries is the vision of "The Mother," a now-deceased French female guru and disciple of Sri Aurobindo, a French educated Indian who returned to his native Pondicherry in the early 20th century with a vision of transforming first India, and later, all of humanity. The Charter of Auroville, signed on the 28th of February, 1968, read as follows:
1. Auroville belongs to nobody in particular. Auroville belongs to humanity as a whole. But to live in Auroville one must be the willing servitor of the Divine Consciousness.
2. Auroville will be the place of an unending education, of constant progress, and a youth that never ages.
3. Auroville wants to be the bridge between the past and the future. Taking advantage of all discoveries from without and from within, Auroville will boldly spring towards futue realisations.
4. Auroville will be a site of material and spiritual researches for a living embodiment of an actual Human Unity.
The Mother dreamed of "somewhere on earth a place which no nation could claim as its own, where all human beings of goodwill who have a sincere aspiration could live freely as citizens of the world and obey one single authority, that of the supreme truth; a place of peace, concord and harmony wher all the fighting instinces of man would be used exclusively to conquer the causes of his sufferings and miseries, to surmount his weaknesses and ignorance, to triumph over his limitations and incapacities; a place where the needs of the spirit and the concern for progress would take precedence over the satisfaction of desires and passions, the search for pleasure and material enjoyment." She wrote much more about this dream and from it sprang a community which occupies a few thousand acres of land that radiates outward in the shape of a spiralling galaxy from a large golden meditation dome, the matrimandir, into four zones: International, Cultural, Residential and Industrial. The once red-earthed and barren platuea is now covered with dry tropical forests, agricultural projects, futuristic concrete buildings and good intentions. Its residents are engaged in "a wide variety of activities, including research into a cashless economy, environmental regeneration, organic farming, renewable energy, appropriate building technology, village development, handicrafts and small-scale industries, health care, education, cross-cultural communication and many other fields."
Reading the postings board at the information center one finds any number of classes pertaining to health and well-being, including all varieties of alternative healing modalities, many of which i'd never heard of. As an example, one gentleman teaches Watsu, shiatsu massage in the water. Some aurovillians, as they are called, are engaged in the cultivation of traditional Indian medicinal plants in order to reeducate the surrounding villagers about traditional remedies that have for the most part been lost to them. It was the occasion of several local healers coming together to explain their work that prompted me to extend my visit to Auroville by one day. Informed of this gathering by a young American now working at Martavum, or "healing forest", i found myself sitting around a large, rectangular slate table with six Canadian nurses, two german Aurovillians, three traditional healers (two women and one man) and Shivaraj, the enthusiastic coordinator of this enterprise. The Canadian nurses were traveling together through India for four weeks, two of which were spent in Auroville running workshops on "healing touch" and women empowerment. They seemed to view their trip as a great success and they seemed flush with excitement about the possibility of learning something from the locals in return. We sipped sweet, milky coffee and asked questions of the healers.
A word, first, about this "forest." Hans, the American, explained that this garden was in its infancy. Unlike the rather well developed Pichandikulum, on the other side of Auroville, the medicinal plants here were still awaiting the growth of the large trees that would provide necessary shade for their optimal growth. The signs to explain their utility were also in a stage of early development and did not yet say anything about the utility of the shrubs and trees they identified. The names, themselves, flowered with possibility: Calotropis Proceria, Pongumia Pinnata, Plumeria Rubra, Gauzuma Ulmifolia, Ervatemia Divancata, Helicteres Isora, Cassia Alata, Ficus Religiosa, Vetiveria Zizanoides, Catharanthus Roseus, Dodnea Viscosa, Acorus Calamus, Gymanaea Sylvestre, Garcinia Spicata. How different these lovely names to those of the pharmacueticals we must learn in the course of medical education?
Sagundala was a women in her 50s who at the age of 27 had a feeling that she could heal people. She makes special use of the Neem (Azadirachta indica, cousin of Mahogany) leaf and, while channeling Mahakali, the great and powerful Indian goddess (wife of Shiva), prays and fans the burning neem leaves. What occurs is a form of "aura cleansing" and she uses it to cure fever, body aches and general malaise. What other purposes it serves were lost in translation from this stout, confident Indian villager. She brought along the white and red powder seen on so many Indian foreheads and blessed us each with a dot between our eyes. I saw her take the hands of one of the German women and reduce the latter to tears as she closed her eyes and prayed, swaying back and forth. I asked about the purpose of Neem oil, which I knew had been blown up the nose of a child, causing a chemical pneumonitis (inflammation of the lungs) that led him to the CMC pediatrics ward. I was told that it is most often diluted in water and used to heal skin lesions and their associated pain. The male of the group suggested that sleeping under the Neem tree in the daytime led a general improvement in health. We learned that 2 teaspoons of ground papaya seeds daily prevents/cures parasites, that sesame oil in the naval also cures parasites, and that conch shells are added to ghee (clarified butter), fired, dried, powdered and dissolved in hot water to stop post-partum bleeding. The flower of Cassia Auriculata is boiled into a tea to cure Diabetes. Melivacaea is smashes, filtered and given in two teaspoons to relieve period pains. While i suspect that these traditional healers would have a cure for most ailments, we learned that the most common complaints among Indian villagers are "stomach problems, headache and colds." With the exception of parasites, theirs sounds a lot like those common problems found in any American clinic.
Today i visited Pichandikulum, another forest of traditional medical plants in a far more developed state, to see what else i could learn, and to see how Martavum might someday look. Here, red dirt pathways wound through a maze of trees, shrubs, little ponds; signs clearly displayed the names and uses for well over a hundred of the 400 or so medicinal plants used at one time or another by traditional Indian healers. I found Curculigo Orchioides, which "cures diabetes, heat diseases, leucoderma, eye pain and strenghtens the body and cures poliomyelitis if administered together with appropriate formulations." The roots of Baliospermum Montanum cure "scanty urination"; the leaves cure asthma; the oil relieves joint pain. Spathoda Companulata bark is used in a concoction to treat dysentary, renal and gastrointestinal problems while the leave is infused to treat urethral inflammations. My curiosity about how they discovered these uses led me to consider how the many drugs we use in allopathic medicine were "discovered". Many of them, no doubt, were derived from plants such as these, used as they are/were by traditional healers.
It is tempting to be skeptical of these various shrubs with their various healing properties. After all, few if any have been subjected to the rigorous system of trials that we use to create the evidence base upon which we practice medicine. And yet, i like to keep an open mind. After all, these remedies have been used for hundreds if not thousands of years. As has Ayurvedic medicine, traditional Chinese medicine, Accupuncture, massage. Allopathic medicine and its pharmacopia are relatively new. The aurovillians, in particular, made sure that i understood that and they seemed to size me up with a certain suspicion. What could i, a western medical student, want to know about this stuff? Surely i wouldn't understand that herbal remedies, barks and flowers, energy and prayer could heal. Ironically, their skepticism of my open mind revealed something more about how closed their own minds seemed to be.
I was forced to defend allopathic medicine many times over the weekend to those that had great confidence in any number of alternative therapies but none in those that i will someday soon have to offer. It was as if, ironically, the type of science upon which my education is based was not welcome there, too much a part of the status quo to have any status in an alternative world. I think all this fighting about who is right and who is wrong when it comes to healing is silly and potentially harmful. It is a clash of egos that benefits least he or she who needs healing. Shouldn't we learn to cater a treatment to the individual rather than an individual to the treatment? Can't we all just get along?
I left Auroville this afternoon and returned to Vellore. I'm happy to be back. While some of the work that is taking place there is encouraging, I was overall discomfited by this aspiring utopia, its aura of neocolonialism and strange inhospitability. I am disappointed because i felt like my open mind has been stepped on - how many times have i been told not to open one's mind so much that it falls out. As I rode my bike through the dusty lanes of Auroville the afternoon, a thought recurred in my mind, a salve to my wounded idealism: It's okay to have one's head in the clouds, as long as one's feet are firmly planted on the ground and one's hands are meaningfully occupied somewhere in between. I'm looking forward to going back to work tomorrow.
Hope you all had a nice monday.
justin
ps. i have so many thoughts about this weekend and my short time in Auroville, i've found it difficult to focus this evening. I'll attribute it in part to long and jarring bus ride. Hell hath no fury like an Indian country road.
pps. The literal definition of "utopia" is "no place."
My guesthouse for the weekend was in the beachside community of Auro Beach, 6km north of Pondicherry, and part of the large international planned community of Auroville. This community of some 1700 people from over 35 countries is the vision of "The Mother," a now-deceased French female guru and disciple of Sri Aurobindo, a French educated Indian who returned to his native Pondicherry in the early 20th century with a vision of transforming first India, and later, all of humanity. The Charter of Auroville, signed on the 28th of February, 1968, read as follows:
1. Auroville belongs to nobody in particular. Auroville belongs to humanity as a whole. But to live in Auroville one must be the willing servitor of the Divine Consciousness.
2. Auroville will be the place of an unending education, of constant progress, and a youth that never ages.
3. Auroville wants to be the bridge between the past and the future. Taking advantage of all discoveries from without and from within, Auroville will boldly spring towards futue realisations.
4. Auroville will be a site of material and spiritual researches for a living embodiment of an actual Human Unity.
The Mother dreamed of "somewhere on earth a place which no nation could claim as its own, where all human beings of goodwill who have a sincere aspiration could live freely as citizens of the world and obey one single authority, that of the supreme truth; a place of peace, concord and harmony wher all the fighting instinces of man would be used exclusively to conquer the causes of his sufferings and miseries, to surmount his weaknesses and ignorance, to triumph over his limitations and incapacities; a place where the needs of the spirit and the concern for progress would take precedence over the satisfaction of desires and passions, the search for pleasure and material enjoyment." She wrote much more about this dream and from it sprang a community which occupies a few thousand acres of land that radiates outward in the shape of a spiralling galaxy from a large golden meditation dome, the matrimandir, into four zones: International, Cultural, Residential and Industrial. The once red-earthed and barren platuea is now covered with dry tropical forests, agricultural projects, futuristic concrete buildings and good intentions. Its residents are engaged in "a wide variety of activities, including research into a cashless economy, environmental regeneration, organic farming, renewable energy, appropriate building technology, village development, handicrafts and small-scale industries, health care, education, cross-cultural communication and many other fields."
Reading the postings board at the information center one finds any number of classes pertaining to health and well-being, including all varieties of alternative healing modalities, many of which i'd never heard of. As an example, one gentleman teaches Watsu, shiatsu massage in the water. Some aurovillians, as they are called, are engaged in the cultivation of traditional Indian medicinal plants in order to reeducate the surrounding villagers about traditional remedies that have for the most part been lost to them. It was the occasion of several local healers coming together to explain their work that prompted me to extend my visit to Auroville by one day. Informed of this gathering by a young American now working at Martavum, or "healing forest", i found myself sitting around a large, rectangular slate table with six Canadian nurses, two german Aurovillians, three traditional healers (two women and one man) and Shivaraj, the enthusiastic coordinator of this enterprise. The Canadian nurses were traveling together through India for four weeks, two of which were spent in Auroville running workshops on "healing touch" and women empowerment. They seemed to view their trip as a great success and they seemed flush with excitement about the possibility of learning something from the locals in return. We sipped sweet, milky coffee and asked questions of the healers.
A word, first, about this "forest." Hans, the American, explained that this garden was in its infancy. Unlike the rather well developed Pichandikulum, on the other side of Auroville, the medicinal plants here were still awaiting the growth of the large trees that would provide necessary shade for their optimal growth. The signs to explain their utility were also in a stage of early development and did not yet say anything about the utility of the shrubs and trees they identified. The names, themselves, flowered with possibility: Calotropis Proceria, Pongumia Pinnata, Plumeria Rubra, Gauzuma Ulmifolia, Ervatemia Divancata, Helicteres Isora, Cassia Alata, Ficus Religiosa, Vetiveria Zizanoides, Catharanthus Roseus, Dodnea Viscosa, Acorus Calamus, Gymanaea Sylvestre, Garcinia Spicata. How different these lovely names to those of the pharmacueticals we must learn in the course of medical education?
Sagundala was a women in her 50s who at the age of 27 had a feeling that she could heal people. She makes special use of the Neem (Azadirachta indica, cousin of Mahogany) leaf and, while channeling Mahakali, the great and powerful Indian goddess (wife of Shiva), prays and fans the burning neem leaves. What occurs is a form of "aura cleansing" and she uses it to cure fever, body aches and general malaise. What other purposes it serves were lost in translation from this stout, confident Indian villager. She brought along the white and red powder seen on so many Indian foreheads and blessed us each with a dot between our eyes. I saw her take the hands of one of the German women and reduce the latter to tears as she closed her eyes and prayed, swaying back and forth. I asked about the purpose of Neem oil, which I knew had been blown up the nose of a child, causing a chemical pneumonitis (inflammation of the lungs) that led him to the CMC pediatrics ward. I was told that it is most often diluted in water and used to heal skin lesions and their associated pain. The male of the group suggested that sleeping under the Neem tree in the daytime led a general improvement in health. We learned that 2 teaspoons of ground papaya seeds daily prevents/cures parasites, that sesame oil in the naval also cures parasites, and that conch shells are added to ghee (clarified butter), fired, dried, powdered and dissolved in hot water to stop post-partum bleeding. The flower of Cassia Auriculata is boiled into a tea to cure Diabetes. Melivacaea is smashes, filtered and given in two teaspoons to relieve period pains. While i suspect that these traditional healers would have a cure for most ailments, we learned that the most common complaints among Indian villagers are "stomach problems, headache and colds." With the exception of parasites, theirs sounds a lot like those common problems found in any American clinic.
Today i visited Pichandikulum, another forest of traditional medical plants in a far more developed state, to see what else i could learn, and to see how Martavum might someday look. Here, red dirt pathways wound through a maze of trees, shrubs, little ponds; signs clearly displayed the names and uses for well over a hundred of the 400 or so medicinal plants used at one time or another by traditional Indian healers. I found Curculigo Orchioides, which "cures diabetes, heat diseases, leucoderma, eye pain and strenghtens the body and cures poliomyelitis if administered together with appropriate formulations." The roots of Baliospermum Montanum cure "scanty urination"; the leaves cure asthma; the oil relieves joint pain. Spathoda Companulata bark is used in a concoction to treat dysentary, renal and gastrointestinal problems while the leave is infused to treat urethral inflammations. My curiosity about how they discovered these uses led me to consider how the many drugs we use in allopathic medicine were "discovered". Many of them, no doubt, were derived from plants such as these, used as they are/were by traditional healers.
It is tempting to be skeptical of these various shrubs with their various healing properties. After all, few if any have been subjected to the rigorous system of trials that we use to create the evidence base upon which we practice medicine. And yet, i like to keep an open mind. After all, these remedies have been used for hundreds if not thousands of years. As has Ayurvedic medicine, traditional Chinese medicine, Accupuncture, massage. Allopathic medicine and its pharmacopia are relatively new. The aurovillians, in particular, made sure that i understood that and they seemed to size me up with a certain suspicion. What could i, a western medical student, want to know about this stuff? Surely i wouldn't understand that herbal remedies, barks and flowers, energy and prayer could heal. Ironically, their skepticism of my open mind revealed something more about how closed their own minds seemed to be.
I was forced to defend allopathic medicine many times over the weekend to those that had great confidence in any number of alternative therapies but none in those that i will someday soon have to offer. It was as if, ironically, the type of science upon which my education is based was not welcome there, too much a part of the status quo to have any status in an alternative world. I think all this fighting about who is right and who is wrong when it comes to healing is silly and potentially harmful. It is a clash of egos that benefits least he or she who needs healing. Shouldn't we learn to cater a treatment to the individual rather than an individual to the treatment? Can't we all just get along?
I left Auroville this afternoon and returned to Vellore. I'm happy to be back. While some of the work that is taking place there is encouraging, I was overall discomfited by this aspiring utopia, its aura of neocolonialism and strange inhospitability. I am disappointed because i felt like my open mind has been stepped on - how many times have i been told not to open one's mind so much that it falls out. As I rode my bike through the dusty lanes of Auroville the afternoon, a thought recurred in my mind, a salve to my wounded idealism: It's okay to have one's head in the clouds, as long as one's feet are firmly planted on the ground and one's hands are meaningfully occupied somewhere in between. I'm looking forward to going back to work tomorrow.
Hope you all had a nice monday.
justin
ps. i have so many thoughts about this weekend and my short time in Auroville, i've found it difficult to focus this evening. I'll attribute it in part to long and jarring bus ride. Hell hath no fury like an Indian country road.
pps. The literal definition of "utopia" is "no place."
CMC - Day Ten
The first order of business on Thursday mornings, bible study, is a reflection of (and on) the Christian roots from which this institution draws its purpose. There is a weekly bible study guide published solely for CMC and the weeks bible passages and lessons are read and discussed throughout the week in numerous small conference rooms across this large campus. Today's discussion centered around the notion of the "mission." If you'll allow me a rare opportunity to quote from the bible: "The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field." So said Jesus as quoted in Matthew 9:37,38, and so have missionaries risen up in response.
The small accompanying reading told of small missionary hospital in north India that was started by a missionary from Scotland who felt god's calling on a trip to India (please understand that i spell "god" with a lower case "g" because my belief is that "god" is in the small things, and in everything; that uppercase "G" enforces, in my mind, an unacceptable distance to they who would draw strength from that energy). "What happened to those who come to CMC from these mission hospitals for training?" the reader is asked, rhetorically. "Are they nurtured? Cared for? Mentored? For most of them the intense training is an exhaustive experience. These are people who go back to the mission hospitals to take up leadership positions. What a great opportunity to invest the lives of these young doctors who will be the leaders of tomorrow?"
Of the 60 undergraduate medical students - i.e. those at my level - that are invited to attend CMC annually, 45 are sponsored by mission hospitals across India. It is not a financial committment, but rather a spiritual one and a bond to a hospital and to patients in communities in India that would otherwise have difficulty attracting physicians. So a discussion of the "mission" has both religious and practical merits. Questions for reflection and discussion were numbered as follows:
1. How can we be involved in a "mission?" Is it going to a rural place in north India, or is it where you are convinced that god has called you to be? Is it the place that matters or the purpose?
2. Is our mission just providing medical care? Where is the place for the Great Commission in this "mission?" In what way are Christian mission hospitals different from other charitable hospitals?
The discussion that ensued revealed something about India. Beryl, the intern i've mentioned before, was asked about her two years mission experience prior to coming back to CMC - she had trained her as an undergraduate. Her time in a small hospital in rural Tamil Nadu was not without its hardships, chief among them was the constant discussions about and demands for money that infected the staff at the hospital, physicians included. Others chimed in with similar experiences. What evolved was not a discussion centered on the purpose of mission hospitals and the doctors that minister there but the corruption of missions, that is apparently endemic. Dr. Peter, the consulting physician, spoke about his experience: the hospital where he spent two years yielded immense profits from the care they provided and from the money they took in from Christian charities abroad. The doctors were poorly paid and the money was channeled into the bishop's pockets and those of their family, which formed a "small mafia" of sorts. This is not, apparently, an uncommon problem. But it is demoralizing. The hospitals end up being cash rich and care poor.
Being a physician is unique because our professional obligations are in and of themselves missionary based. The first line of the Geneva Convention, which we recite as early as our first year of medical school, says: "I solemnly pledge to consecrate my life to the service of humanity." Christian doctors in a Christian hospital have, in some sense, a double mission, a professional and a religious obligation. I explained to the doctors around our little conference table that physicians and medicine are not free of corruption in the U.S. We nurse a relationship with the pharmacuetical industry that benefits the least our patients; we have a system of healthcare that benefits the most those with the greatest conflicts of interest and bankrupts those who choose to utilize it. What should be seen as the biggest scandal, that we pay double per capita what other industrialized nations pay and have neither a completely insured public nor the health indicators to show for it, is not known, ignored, or, worse, accepted. And so we have the challenge, in a relatively secular medical world, of engendering in students and physicians a sense of purpose, or "mission," that will lead them to refuse the inequities of the status quo, that will lead them to change the system for the sake of our patients. How, i asked, can medical education in India train its graduates not to accept the corruption that exists in the missionary hospitals (or any hospital for that matter)? From what can a Christian medical education, or medical model, draw to teach the rest of medicine about what a "mission" really is? No one around the table could say. What it is certainly not a mission is worrying about inadequate salaries while a hospital and its administrators get rich and the patients suffer? (Put that way, our healthcare system doesn't seem so different from theirs.)
I read an editorial in the Journal of the Mahatma Gandhi Institute of Medical Sciences about medical education in India and how it must shed the standards of training it inherited from the English. The author, an Indian physician now based in the U.S., laments the current and rigorous system of rote memorization of all facts medical. He argues in favor of medical education that emphasizes more the humanities, one that reinforces our central humanness, and might allow Indian medical graduates to more readily empathize with their patients by understanding better who they are and where they come from. The system, he continues, must reinforce patient care rather than patient illness. His suggestions mirror changes in medical education that we've seen in the U.S. in recent years, something for which we should be grateful. Maybe, too, this focus on humanities offers a solution to this question about how to instill in students awareness of their professional mission. After all, in the face of corruption and inequality, it's much easier to advocate for a human than a disease.
On the clinical front, we stared incredulously this morning at a CT scan of the brain of a beautiful young girl admitted for recurrent episodes of staphylococcal meningitis. It showed that the "polyp" we'd seen peaking out of her right nose was actually part of her brain. This young girl has a very rare intranasal encephalocele. We returned to bedside with our flashlight and sure enough we could see a flattened gyrus and minute blood vessels of that essential organ which should be inside the head, not out. This girl will have to have surgery to put it back and to close up the hole that let it out.
I'm off to the beach again, this time in Pondicherry, a former French colony about an hour south of Mahabalipuram. My mission, this weekend, is to find a flaky and warm croissant. I'll let you know how it goes.
bon weekend.
justin
One more thing...
Though not a Christian, i think these weekly bible discussions to discuss faith are probably invaluable to the physicians here. We could do with such a thing, just like we could use a set morning coffee break. Whether a Christian, a Hindu, a Muslim or an existentialist, discussions about how our individual faiths contribute to the practice of medicine could only make us better physicians. After all, if we cannot discuss these things amongst ourselves, how can we be expected to do so with patients. When it comes to improving their quality of lives, understanding what spiritual reserves they bring to achieving that lifestyle is critical.
The small accompanying reading told of small missionary hospital in north India that was started by a missionary from Scotland who felt god's calling on a trip to India (please understand that i spell "god" with a lower case "g" because my belief is that "god" is in the small things, and in everything; that uppercase "G" enforces, in my mind, an unacceptable distance to they who would draw strength from that energy). "What happened to those who come to CMC from these mission hospitals for training?" the reader is asked, rhetorically. "Are they nurtured? Cared for? Mentored? For most of them the intense training is an exhaustive experience. These are people who go back to the mission hospitals to take up leadership positions. What a great opportunity to invest the lives of these young doctors who will be the leaders of tomorrow?"
Of the 60 undergraduate medical students - i.e. those at my level - that are invited to attend CMC annually, 45 are sponsored by mission hospitals across India. It is not a financial committment, but rather a spiritual one and a bond to a hospital and to patients in communities in India that would otherwise have difficulty attracting physicians. So a discussion of the "mission" has both religious and practical merits. Questions for reflection and discussion were numbered as follows:
1. How can we be involved in a "mission?" Is it going to a rural place in north India, or is it where you are convinced that god has called you to be? Is it the place that matters or the purpose?
2. Is our mission just providing medical care? Where is the place for the Great Commission in this "mission?" In what way are Christian mission hospitals different from other charitable hospitals?
The discussion that ensued revealed something about India. Beryl, the intern i've mentioned before, was asked about her two years mission experience prior to coming back to CMC - she had trained her as an undergraduate. Her time in a small hospital in rural Tamil Nadu was not without its hardships, chief among them was the constant discussions about and demands for money that infected the staff at the hospital, physicians included. Others chimed in with similar experiences. What evolved was not a discussion centered on the purpose of mission hospitals and the doctors that minister there but the corruption of missions, that is apparently endemic. Dr. Peter, the consulting physician, spoke about his experience: the hospital where he spent two years yielded immense profits from the care they provided and from the money they took in from Christian charities abroad. The doctors were poorly paid and the money was channeled into the bishop's pockets and those of their family, which formed a "small mafia" of sorts. This is not, apparently, an uncommon problem. But it is demoralizing. The hospitals end up being cash rich and care poor.
Being a physician is unique because our professional obligations are in and of themselves missionary based. The first line of the Geneva Convention, which we recite as early as our first year of medical school, says: "I solemnly pledge to consecrate my life to the service of humanity." Christian doctors in a Christian hospital have, in some sense, a double mission, a professional and a religious obligation. I explained to the doctors around our little conference table that physicians and medicine are not free of corruption in the U.S. We nurse a relationship with the pharmacuetical industry that benefits the least our patients; we have a system of healthcare that benefits the most those with the greatest conflicts of interest and bankrupts those who choose to utilize it. What should be seen as the biggest scandal, that we pay double per capita what other industrialized nations pay and have neither a completely insured public nor the health indicators to show for it, is not known, ignored, or, worse, accepted. And so we have the challenge, in a relatively secular medical world, of engendering in students and physicians a sense of purpose, or "mission," that will lead them to refuse the inequities of the status quo, that will lead them to change the system for the sake of our patients. How, i asked, can medical education in India train its graduates not to accept the corruption that exists in the missionary hospitals (or any hospital for that matter)? From what can a Christian medical education, or medical model, draw to teach the rest of medicine about what a "mission" really is? No one around the table could say. What it is certainly not a mission is worrying about inadequate salaries while a hospital and its administrators get rich and the patients suffer? (Put that way, our healthcare system doesn't seem so different from theirs.)
I read an editorial in the Journal of the Mahatma Gandhi Institute of Medical Sciences about medical education in India and how it must shed the standards of training it inherited from the English. The author, an Indian physician now based in the U.S., laments the current and rigorous system of rote memorization of all facts medical. He argues in favor of medical education that emphasizes more the humanities, one that reinforces our central humanness, and might allow Indian medical graduates to more readily empathize with their patients by understanding better who they are and where they come from. The system, he continues, must reinforce patient care rather than patient illness. His suggestions mirror changes in medical education that we've seen in the U.S. in recent years, something for which we should be grateful. Maybe, too, this focus on humanities offers a solution to this question about how to instill in students awareness of their professional mission. After all, in the face of corruption and inequality, it's much easier to advocate for a human than a disease.
On the clinical front, we stared incredulously this morning at a CT scan of the brain of a beautiful young girl admitted for recurrent episodes of staphylococcal meningitis. It showed that the "polyp" we'd seen peaking out of her right nose was actually part of her brain. This young girl has a very rare intranasal encephalocele. We returned to bedside with our flashlight and sure enough we could see a flattened gyrus and minute blood vessels of that essential organ which should be inside the head, not out. This girl will have to have surgery to put it back and to close up the hole that let it out.
I'm off to the beach again, this time in Pondicherry, a former French colony about an hour south of Mahabalipuram. My mission, this weekend, is to find a flaky and warm croissant. I'll let you know how it goes.
bon weekend.
justin
One more thing...
Though not a Christian, i think these weekly bible discussions to discuss faith are probably invaluable to the physicians here. We could do with such a thing, just like we could use a set morning coffee break. Whether a Christian, a Hindu, a Muslim or an existentialist, discussions about how our individual faiths contribute to the practice of medicine could only make us better physicians. After all, if we cannot discuss these things amongst ourselves, how can we be expected to do so with patients. When it comes to improving their quality of lives, understanding what spiritual reserves they bring to achieving that lifestyle is critical.
CMC - Day Nine
At the end of each day I ask one of the residents or the consulting physician what time I should arrive the next morning. They always say 8 o'clock. So every morning at 8 am I ascend the 10 flights of stairs to the 5th floor, pass the row of bored fathers sitting on the ground outside the ward (only one parent at a time is allowed in) and make my way to the Child Health library, with its old wooden and rusty metal cabinets full of a poorly arranged but impressive collection of pediatrics textbooks. And every morning i'm the only one there. Usually we get started around 9. This 8 am business must be wishful thinking.
This morning i sat down to find a discarded section of yesterday's Indian Express newspaper, this one for school children. On the front page was a discussion of a survey recently published by the British Medical Journal on the 15 most important advances in medicine since 1840, when the journal was first published. Over 11,000 BMJ readers replied and they selected "sanitation" as the most important advance in 166 years. A BMJ article on sanitation that preceeded the survey noted that sewage disposal and water supply systems in 1800s radically improved public health in Europe. In his Sanitary Conditions of the Labouring Population, published in 1842, Edwin Chadwick argued that a desperate need for public health reform must include home sewage piping with water. A few years later, in 1854, Dr. John Snow discovered that cholera was a waterborn disease, not airborne as had been previously believed. That few of us have ever seen cholera in a developed country is a testament to their good work.
Interestingly, and briefly, the first toilet was constructed in England by a godson to Queen Elizabeth 1, Sir John Harrington. He sought to make a "necessary" for himself and his godmother as early as 1596, a feat that brought him little reward and much ridicule. Thus began toilet humour.
According to the World Health Organization, diarrheal disease alone amounts to an estimated 4.1% of the global burden of disease (as measured by disability-adjusted life years, a topic i won't go into) and is responsible for 1.8 million deaths every year. It is estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygeine, and is concentrated in children in developing countries.
Here in Vellore, one need look no further than my front doorstep to see that this problem still exists here. Let me tell you about my morning walk to work. I step off the first red marble step of Sri Nathan Palace onto a narrow paved dirt and brick alley that is my "street." The first person I see is my barber, sitting in the rusty blue tin stilted shack in which i get my thrice-weekly straight-razor shave. He's managed to perfect the art of delivering the perfect shave while tilted at a 15 degree angle. Waving as i pass, i quickly come to my chai wallah. Wallah, in common parlance, means "one who is engaged in," and he engages very well in my morning, afternoon, and sometimes evening chai. He has a lovely, tall and frighteningly thin young boy with a beautiful smile that works with him, a non-filial relationship i've not quite figured out, but who seems to like me very much and we're always waving at each other. I grab a seat on a plastic blue stool and contemplate the morning while the chai-man works his milk, sugar, and tea powder magic. I wave to the ironing man who's roadside office consists of a board set against the wall, its street end balanced on two thin wooden sticks. He pulls coal from a sac and places inside his giant iron before lighting it up for a morning's work. There's a man selling shirts, one selling brooms, and another selling the stainless steel and nested "tiffen" sets in which so many Indians carry their food to work or school with them. A rickshaw will make it's way precariously down the street. Bicycle bells ring out periodically. A man sells south indian food on a small table: iddlies, dosas, sambar. Fresh fried vadas are cooked in large vats of oil. People mill about. It's a wonderful little street. Oh, but i didn't tell you about the hazards. Each side of this little street is lined with large rectangular concrete slabs, layed perpindicularly to the street. Gaps in these slabs are not uncommon and what does one find beneath but the open sewer? One's nose confirms what one's eyes won't forget: the contents of so many toilets floating in a river of muck. So in avoiding the occasional cow paddy, or cow, or rickshaw, or bicycle, one must be careful to not step too far to the side, or else end up in the sewer. Yikes! The reality is that it is not so different from early 19th century England.
I spent the morning at a small rural satelite community hospital in a vellage outside Vellore. The clinic is called RUHSA, the Rural Unit for Health and Social Affairs. On Thursdays one of the more senior residents (today it was Praburam) hosts an outpatient clinic for those more complicated cases identified throughout the rest of the week. In a room no larger than 10x40ft, four physicians held court as a parade of patients, adults and children, lined up to see them. No fewer than 6 children at a time waited in front of Dr. Praburam's desk, each listening patiently to the stories of those in front of them. There is no such thing as privacy here and one hopes that, if anything, this communal suffering leads to a more communal empathy. We saw about 40 children in 4 hours. Nearly half of them had symptoms, lab tests and chest x-rays concerning for tuberculosis. Western pediatricians are grateful that we no longer (or very rarely) have to contend with this consuming illness. Fortunately, thanks to clinics like this one, children are being identified early and are subsequently getting the treatment that will likely save their lives.
I spent the afternoon at The Swimming Pool, a tranquil and sunny private oasis that abuts the undergraduate medical campus. It's an escape from open sewers and acid-fast bacilli (the type of bacteria that cause tuberculosis) and the endless and nearly unavoidable honking of horns. Some sentence fragments: an olympic sized pool surrounded by palm trees and lush and shortly-shorn grass; a cold coca cola in one hand; a good book in the other. What better way to contemplate the mornings events and what a guilty pleasure?
Life's not all bad.
justin
This morning i sat down to find a discarded section of yesterday's Indian Express newspaper, this one for school children. On the front page was a discussion of a survey recently published by the British Medical Journal on the 15 most important advances in medicine since 1840, when the journal was first published. Over 11,000 BMJ readers replied and they selected "sanitation" as the most important advance in 166 years. A BMJ article on sanitation that preceeded the survey noted that sewage disposal and water supply systems in 1800s radically improved public health in Europe. In his Sanitary Conditions of the Labouring Population, published in 1842, Edwin Chadwick argued that a desperate need for public health reform must include home sewage piping with water. A few years later, in 1854, Dr. John Snow discovered that cholera was a waterborn disease, not airborne as had been previously believed. That few of us have ever seen cholera in a developed country is a testament to their good work.
Interestingly, and briefly, the first toilet was constructed in England by a godson to Queen Elizabeth 1, Sir John Harrington. He sought to make a "necessary" for himself and his godmother as early as 1596, a feat that brought him little reward and much ridicule. Thus began toilet humour.
According to the World Health Organization, diarrheal disease alone amounts to an estimated 4.1% of the global burden of disease (as measured by disability-adjusted life years, a topic i won't go into) and is responsible for 1.8 million deaths every year. It is estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygeine, and is concentrated in children in developing countries.
Here in Vellore, one need look no further than my front doorstep to see that this problem still exists here. Let me tell you about my morning walk to work. I step off the first red marble step of Sri Nathan Palace onto a narrow paved dirt and brick alley that is my "street." The first person I see is my barber, sitting in the rusty blue tin stilted shack in which i get my thrice-weekly straight-razor shave. He's managed to perfect the art of delivering the perfect shave while tilted at a 15 degree angle. Waving as i pass, i quickly come to my chai wallah. Wallah, in common parlance, means "one who is engaged in," and he engages very well in my morning, afternoon, and sometimes evening chai. He has a lovely, tall and frighteningly thin young boy with a beautiful smile that works with him, a non-filial relationship i've not quite figured out, but who seems to like me very much and we're always waving at each other. I grab a seat on a plastic blue stool and contemplate the morning while the chai-man works his milk, sugar, and tea powder magic. I wave to the ironing man who's roadside office consists of a board set against the wall, its street end balanced on two thin wooden sticks. He pulls coal from a sac and places inside his giant iron before lighting it up for a morning's work. There's a man selling shirts, one selling brooms, and another selling the stainless steel and nested "tiffen" sets in which so many Indians carry their food to work or school with them. A rickshaw will make it's way precariously down the street. Bicycle bells ring out periodically. A man sells south indian food on a small table: iddlies, dosas, sambar. Fresh fried vadas are cooked in large vats of oil. People mill about. It's a wonderful little street. Oh, but i didn't tell you about the hazards. Each side of this little street is lined with large rectangular concrete slabs, layed perpindicularly to the street. Gaps in these slabs are not uncommon and what does one find beneath but the open sewer? One's nose confirms what one's eyes won't forget: the contents of so many toilets floating in a river of muck. So in avoiding the occasional cow paddy, or cow, or rickshaw, or bicycle, one must be careful to not step too far to the side, or else end up in the sewer. Yikes! The reality is that it is not so different from early 19th century England.
I spent the morning at a small rural satelite community hospital in a vellage outside Vellore. The clinic is called RUHSA, the Rural Unit for Health and Social Affairs. On Thursdays one of the more senior residents (today it was Praburam) hosts an outpatient clinic for those more complicated cases identified throughout the rest of the week. In a room no larger than 10x40ft, four physicians held court as a parade of patients, adults and children, lined up to see them. No fewer than 6 children at a time waited in front of Dr. Praburam's desk, each listening patiently to the stories of those in front of them. There is no such thing as privacy here and one hopes that, if anything, this communal suffering leads to a more communal empathy. We saw about 40 children in 4 hours. Nearly half of them had symptoms, lab tests and chest x-rays concerning for tuberculosis. Western pediatricians are grateful that we no longer (or very rarely) have to contend with this consuming illness. Fortunately, thanks to clinics like this one, children are being identified early and are subsequently getting the treatment that will likely save their lives.
I spent the afternoon at The Swimming Pool, a tranquil and sunny private oasis that abuts the undergraduate medical campus. It's an escape from open sewers and acid-fast bacilli (the type of bacteria that cause tuberculosis) and the endless and nearly unavoidable honking of horns. Some sentence fragments: an olympic sized pool surrounded by palm trees and lush and shortly-shorn grass; a cold coca cola in one hand; a good book in the other. What better way to contemplate the mornings events and what a guilty pleasure?
Life's not all bad.
justin
CMC - Day Eight
As she began a patient visit this morning with a young Bengali family, Beryl, one of my favorite interns on the team, advised that when interviewing families, one ask what is the primary purpose for their visit to CMC. It is likely to tell one about the urgency of a child's presentation. In the case of this family, the grandfather was here receiving treatment for some ailment or another. They had brought their daughter in out of convenience. Cute as a button - cute being the 5th vital sign in kids, along with temperature, blood pressure, pulse and respiratory rate - with short black hair, wide brown eyes, and lips pursed in shyness, this young lady looked very healthy. Her chief complaint was actually not hers at all; her parents were concerned about her hyperpigmented tongue. I ask you to understand the word hyperpigmentation in the lightest sense possible. Her tongue appeared only slightly darker than the child that had come before her and she exhibited none of the greyish to black (or even hairy) hyperpigmentation that can be seen in Addison's disease (or, for medical folks: Peutz-Jeghers syndrome, melanoma, amalgam tattoo, toxic reactions to various metals, hemochromatosis, pernicious anemia, scleroderma, Laugier-Hunziker syndrome), or that present as a rare side effect of using certain medications, among them antimilarials, minocycline (for acne), and doxorubicin (for anticancer activity.) In truth, her parents complaint was more cosmetic than medical. Beryl seemed to think that it had something to do with the girls marital eligibility some day. One might be tempted to think that in a country where a family is so much more likely to struggle for the basic things in life that such superficial concerns would be a trifle.
Not so. In India, as in most countries of the world where skin is naturally darker, one finds an assortment of skin-bleaching products on the shelves of even the smallest corner stores. They are advertised extensively, in newspapers, tabloids, billboards. In matters of the skin, is the grass always greener? A few weeks ago i wrote to a new friend, Elizabeth of Uganda, a woman with the most stunning ebony skin, and told her of plans to head to the beach - must tread carefully here as my dermatologist is recieving these dispatches. "Wish you luck with your tanning," she wrote back. "Isn't it amazing? The whites want to be dark so they tan themselves and the blacks want to be light so they bleach themselves! Why we werent given the choice i don't understand. It would make for an easier life. One day white and one day black." I love this idea; it had never before occurred to me. I'm not so sure it would solve any problems, though. Surely skin color would be subject to the same fads that present themselves in all the other areas of our lives in which we have choices. Such a thing might have the positive effect of teaching us all how unimportant skin color really is when it comes down to it. As an aside, in the west the most successful medical students often go on to choose careers like dermatology, which offers good medicine, great hours and a grand income. I mentioned this to the residents over coffee the other day, and to their surprise. In India, despite all this concern about the skin, i'm happy to report that the most competitive fields are in primary care.
We heard an interesting lecture today from the developmental pediatrics team on a condition called Hemiconvulsion, Hemiplegia, and Epilepsy (HHE). This rare phenomena has two types, distinguished by their mechanism of onset. Type I comes about in most cases following an infection in the central nervous system - meningitis or encephalitis - and Type II is called idiopathic because it seems to originate without a cause (but is often referred to as an atypical febrile seizure). The course of illness goes something like this: children usually under the age of four develop a prolonged seizure either as a result of illness or not. This seizure causes damage to the brain tissue which leads in some time to either a flaccid, spastic, or flaccid then spastic paralysis on one side of the body (hemiplegia). Most often it resolves, at least in part; sometimes it does not. In a period that varies in time (in the largest observational studies) from 1.5 to 12 years, children experience the onset of epilepsy. The lecturer raised an interesting point, one that exceeds most peoples understanding of epilepsy: seizures are only one symptom of epilepsy. Many of the children identified with HHE have epileptic seizures only rarely. Depending on where the initial damage took place in the brain, children's motor skills, spatial awareness, verbal fluency, and behavior could, and are, affected. The children identified in the department at CMC presented with rather severe behavioral problems. Now for the treatment: hemispherectomy. That is, they take out the part of the brain that is affected. What has been shown is that not only has seizure activity been eliminated or improved in most cases, behavioral problems have also improved. (for those interested in the article, the reference is: Devlin et al. Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain, Vol. 126, No. 3, 556-566, March 2003. you can google it.) Now, what some were wondering, myself among them, was if the children's behavior improved for some other reason than the removal of bad brain tissue. Perhaps the recognized punishment of having part of one's brain removed was enough to get kids to shape up. Take note: the threat of such an operation might be an effective parenting tool in times of bad behavior. In all seriousness, it's a remarkable procedure, one performed with great awareness about what parts of the brain are affected adversely and which are not. With imaging techniques becoming more and more sophisticated by the day -
Medicine is exciting because it concerns itself with the skin, the mind, and everything in between. As the young child with the slighly more purple tongue was being examined, on the chair next to her (remember that there are often two exams going on in the same room at the same time by two different doctors) was a young girl with a cleft lip and palate. She was cute too, a happy and playful child. She had come to CMC for surgery to correct the split in the roof of her mouth and lip, surgery which had been delayed because she had developed a cold. As we examined the child with the cleft lip i noticed that the mother of the other girl kept looking over to watch the former. She could hardly take her eyes of the little one. I wonder if seeing this child with this obvious deformity, correctable though it is, made her think about the complaint she had for her own daughter. I wonder if it made her grateful for what she had.
I'm grateful to be in India and grateful to have friends like you.
justin
ps. As i write, a young physician in the computer room in front of me is surreptitiously surfing the web for photos of his favorite female Tamil film stars, most of whom have fairer skin. It's a funny site and one i see almost everyday. Young male students and doctors gaze at their computer screens, ready, when someone walks by, to pull up another page that would make it appear that they are actually working.
Not so. In India, as in most countries of the world where skin is naturally darker, one finds an assortment of skin-bleaching products on the shelves of even the smallest corner stores. They are advertised extensively, in newspapers, tabloids, billboards. In matters of the skin, is the grass always greener? A few weeks ago i wrote to a new friend, Elizabeth of Uganda, a woman with the most stunning ebony skin, and told her of plans to head to the beach - must tread carefully here as my dermatologist is recieving these dispatches. "Wish you luck with your tanning," she wrote back. "Isn't it amazing? The whites want to be dark so they tan themselves and the blacks want to be light so they bleach themselves! Why we werent given the choice i don't understand. It would make for an easier life. One day white and one day black." I love this idea; it had never before occurred to me. I'm not so sure it would solve any problems, though. Surely skin color would be subject to the same fads that present themselves in all the other areas of our lives in which we have choices. Such a thing might have the positive effect of teaching us all how unimportant skin color really is when it comes down to it. As an aside, in the west the most successful medical students often go on to choose careers like dermatology, which offers good medicine, great hours and a grand income. I mentioned this to the residents over coffee the other day, and to their surprise. In India, despite all this concern about the skin, i'm happy to report that the most competitive fields are in primary care.
We heard an interesting lecture today from the developmental pediatrics team on a condition called Hemiconvulsion, Hemiplegia, and Epilepsy (HHE). This rare phenomena has two types, distinguished by their mechanism of onset. Type I comes about in most cases following an infection in the central nervous system - meningitis or encephalitis - and Type II is called idiopathic because it seems to originate without a cause (but is often referred to as an atypical febrile seizure). The course of illness goes something like this: children usually under the age of four develop a prolonged seizure either as a result of illness or not. This seizure causes damage to the brain tissue which leads in some time to either a flaccid, spastic, or flaccid then spastic paralysis on one side of the body (hemiplegia). Most often it resolves, at least in part; sometimes it does not. In a period that varies in time (in the largest observational studies) from 1.5 to 12 years, children experience the onset of epilepsy. The lecturer raised an interesting point, one that exceeds most peoples understanding of epilepsy: seizures are only one symptom of epilepsy. Many of the children identified with HHE have epileptic seizures only rarely. Depending on where the initial damage took place in the brain, children's motor skills, spatial awareness, verbal fluency, and behavior could, and are, affected. The children identified in the department at CMC presented with rather severe behavioral problems. Now for the treatment: hemispherectomy. That is, they take out the part of the brain that is affected. What has been shown is that not only has seizure activity been eliminated or improved in most cases, behavioral problems have also improved. (for those interested in the article, the reference is: Devlin et al. Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain, Vol. 126, No. 3, 556-566, March 2003. you can google it.) Now, what some were wondering, myself among them, was if the children's behavior improved for some other reason than the removal of bad brain tissue. Perhaps the recognized punishment of having part of one's brain removed was enough to get kids to shape up. Take note: the threat of such an operation might be an effective parenting tool in times of bad behavior. In all seriousness, it's a remarkable procedure, one performed with great awareness about what parts of the brain are affected adversely and which are not. With imaging techniques becoming more and more sophisticated by the day -
Medicine is exciting because it concerns itself with the skin, the mind, and everything in between. As the young child with the slighly more purple tongue was being examined, on the chair next to her (remember that there are often two exams going on in the same room at the same time by two different doctors) was a young girl with a cleft lip and palate. She was cute too, a happy and playful child. She had come to CMC for surgery to correct the split in the roof of her mouth and lip, surgery which had been delayed because she had developed a cold. As we examined the child with the cleft lip i noticed that the mother of the other girl kept looking over to watch the former. She could hardly take her eyes of the little one. I wonder if seeing this child with this obvious deformity, correctable though it is, made her think about the complaint she had for her own daughter. I wonder if it made her grateful for what she had.
I'm grateful to be in India and grateful to have friends like you.
justin
ps. As i write, a young physician in the computer room in front of me is surreptitiously surfing the web for photos of his favorite female Tamil film stars, most of whom have fairer skin. It's a funny site and one i see almost everyday. Young male students and doctors gaze at their computer screens, ready, when someone walks by, to pull up another page that would make it appear that they are actually working.
CMC - Day Seven
Indians must be among the greatest consumers of printed news in the world. This morning on my way to work I passed a news agent. His stand consists of a rusty bicycle covered in daily newspapers. You can't imagine how he gets all of the newspapers and magazines to fit on this bicycle and I don't even know how to describe it. I will say that, in addition to the various weekly news magazines, mini-tabloids, lifestyle magazines and horoscopes, he had on display twenty different daily newspapers. And these are just the morning editions. There are three in English - The Indian Express, The Hindu Times, and (my favorite) The Deccan Chronicle - several in Tamil, a few in Malayalam and some that appear to be in Bengali. My comparitive alphabet skills are not great so i could be wrong about the numbers and languages of a few of them. Click here for an online version of one of them: http://www.andhrabhoomi.net/ Either way, there are lots of papers in several languages and, while relatively thin papers (during the week), it's a lot of news to go around. And lots of paper. This particular news agent has a stand that is one of hundreds across this small city, one of thousands across the state, and one of probably more than a million across the country. The Indians take their news very seriously.
Having only read the English dailies, i can speak knowledgably about their content only. Usually, it starts of with the big local or regional news, is followed by the national news, then the Op-Ed pages. The Indian public seems to relish political commentary and the Op-Ed pages are my favorite to read. On most days, they will also syndicate essays from the op-ed writers at the New York Times. These days, the pages are wet with criticism of the Bush administration and current American diplomatic strategies (an unfortunate few upon which to comment). The Op-Ed pages are followed by International news, then business, then sports. The "sports" section is really the "cricket" section and, unfortunately, one can learn very little about this confusing game from the thousands of words that go into the daily analyses of what teams and their players are up to. In this section one also finds the Soduku puzzle, which has become its own sport in India. Aside from the cricket, their papers are not so different from our own.
Until you get to the extra sections. I think the Indians must have inherited their love of celebrity gossip from the English, the difference being that all the celebrities in India are film (say "filim") stars. Since i arrived the biggest news has been the impending marriage of Aishwayai Rai, a bollywood starlet, and Abhishek Bachchan, son of Bollywood's biggest star, Amitabh Bachchan. This is a major affair and the press seem to be following it more closely than just about anything else. Anyway, there seem to be hundreds of Bollywood stars and each day brings new interviews with actors old and new. Accompanying these pages are often write-in columns for teens, which reveal the changing face of Indian courtship. "Nandu the Nerd" is my favorite. These are from this weeks column:
Q. I am an 18-year-old boy in love with a girl. The problem is that we both belong to different religions. I want to marry her, is this possible? Ajay
A. The questions you should be asking are, 'Does she love me?' and 'Will she want to date me now to begin with?' At 18 you really have to be thick to be thinking about marriage. No youngster with a happening life and smart head will be thinking about lifelong commitments and other boring stuff at your age.
Q. I have been going out with my boyfriend for four years now. Recently when I brought up the topic of marriage he said he couldn't marry me due to his family. After that we just say hi and bye to each other when we meet. But we can't forget each other, what should I do? Soniya
A. What's with the marriage bug that is infecting you guys? Do you have no self-respect? This guy doesn't love you, usually when matters of the heart are concerned things like family aren't taken into consideration. There is zero passion from his side, so quit playing the tragedy queen and get a life.
Perhaps it is only the English newspapers that reveal a side of love with which few, although more and more, Indians are familiar. "Law marriages", as they are called, are those that are not arranged by parents. That is, they happen more or less like marriages in the west. Young Indians must tread carefully though in this matter as the potential consequences of a badly perceived coupling are tragic. Last week I read of two distant cousins who had fallen in love. Their family, aware of their feelings, disapproving of their relationship, and fearful of its (karmic? practical?) consequences, conspired to steal them from their homes, torture them, kill them, chop them into pieces and then set them on fire in a ditch. Tradition, Religion, Caste: these are still major players in Indian love
The classified are different from our own in that most include several pages of "matrimonials," a modern twist on the ancient practice of arranged marriage. They tend to emphasize education, family members education, and religion. Two examples:
30 year old Hindu Indian Resident of Caste Hindu-Jat: "She is a very smart, very talented and very intelligent girl. She is working as advocate, interior designer and vastu fengshui consultate side by side she is studying M.B.A. too. We are looking for Class 1 officer, Doctor, Architect, IT Professional, or a Advocate having well established practive in delhi courts."
28 year old Hindu Kerala Iyer girl: "We are looking for an alliance for our elder daughter. She is an innocent divorcee with no encumbrance and her marriage was not consummated. She is very beautiful, fair, intelligent, god fearing, family oriented with traditional values. We are looking for professionally qualified & wellplaced Iyer boys preferably located at Bangalore, god fearing, caring and understanding and with respect for family values."
Fortunately, in addition to being great consumers of newsprint, they are also great recyclers, although not in the way you would imagine. Yesterday i left work and stopped at the large bicycle cart of a man selling bananas. I purchased my bananas and he pulled out a large perfectly torn section of newspaper and with it wrapped my bananas, using a string to tie it all up.. My next stop was the pharmacy: i left not two minutes later with a new bottle of face wash wrapped, you guessed it, in another perfectly torn piece of newspaper. Hungry for a snack i stopped at another street stall and picked up a samosa, wrapped in newspaper. On my way to my final stop, the laundry, i passed a seller of freshly roasted peanuts served in cones of newspaper. I picked up my two freshly pressed shirts, folded around appropriately sized and torn newspaper, and my trousers. All of it was folded and tucked in yet more newspaper. Had i not stopped them, all of these paper-wrapped items would have ended up inside a little plastic bag as well. One would be tempted to conclude that all of this newsprint exists to more neatly wrap up the other transactions of daily living.
So, what does this all have to do with medicine? Very little. But it has much to do with health, to which all these cultural idiosyncracies contribute.
Not an exciting day on the wards. Wish i'd had a newspaper to read.
justin
ps. The young boy with the liver failure, about whom i wrote yesterday, was both more alert and interactive today.
Having only read the English dailies, i can speak knowledgably about their content only. Usually, it starts of with the big local or regional news, is followed by the national news, then the Op-Ed pages. The Indian public seems to relish political commentary and the Op-Ed pages are my favorite to read. On most days, they will also syndicate essays from the op-ed writers at the New York Times. These days, the pages are wet with criticism of the Bush administration and current American diplomatic strategies (an unfortunate few upon which to comment). The Op-Ed pages are followed by International news, then business, then sports. The "sports" section is really the "cricket" section and, unfortunately, one can learn very little about this confusing game from the thousands of words that go into the daily analyses of what teams and their players are up to. In this section one also finds the Soduku puzzle, which has become its own sport in India. Aside from the cricket, their papers are not so different from our own.
Until you get to the extra sections. I think the Indians must have inherited their love of celebrity gossip from the English, the difference being that all the celebrities in India are film (say "filim") stars. Since i arrived the biggest news has been the impending marriage of Aishwayai Rai, a bollywood starlet, and Abhishek Bachchan, son of Bollywood's biggest star, Amitabh Bachchan. This is a major affair and the press seem to be following it more closely than just about anything else. Anyway, there seem to be hundreds of Bollywood stars and each day brings new interviews with actors old and new. Accompanying these pages are often write-in columns for teens, which reveal the changing face of Indian courtship. "Nandu the Nerd" is my favorite. These are from this weeks column:
Q. I am an 18-year-old boy in love with a girl. The problem is that we both belong to different religions. I want to marry her, is this possible? Ajay
A. The questions you should be asking are, 'Does she love me?' and 'Will she want to date me now to begin with?' At 18 you really have to be thick to be thinking about marriage. No youngster with a happening life and smart head will be thinking about lifelong commitments and other boring stuff at your age.
Q. I have been going out with my boyfriend for four years now. Recently when I brought up the topic of marriage he said he couldn't marry me due to his family. After that we just say hi and bye to each other when we meet. But we can't forget each other, what should I do? Soniya
A. What's with the marriage bug that is infecting you guys? Do you have no self-respect? This guy doesn't love you, usually when matters of the heart are concerned things like family aren't taken into consideration. There is zero passion from his side, so quit playing the tragedy queen and get a life.
Perhaps it is only the English newspapers that reveal a side of love with which few, although more and more, Indians are familiar. "Law marriages", as they are called, are those that are not arranged by parents. That is, they happen more or less like marriages in the west. Young Indians must tread carefully though in this matter as the potential consequences of a badly perceived coupling are tragic. Last week I read of two distant cousins who had fallen in love. Their family, aware of their feelings, disapproving of their relationship, and fearful of its (karmic? practical?) consequences, conspired to steal them from their homes, torture them, kill them, chop them into pieces and then set them on fire in a ditch. Tradition, Religion, Caste: these are still major players in Indian love
The classified are different from our own in that most include several pages of "matrimonials," a modern twist on the ancient practice of arranged marriage. They tend to emphasize education, family members education, and religion. Two examples:
30 year old Hindu Indian Resident of Caste Hindu-Jat: "She is a very smart, very talented and very intelligent girl. She is working as advocate, interior designer and vastu fengshui consultate side by side she is studying M.B.A. too. We are looking for Class 1 officer, Doctor, Architect, IT Professional, or a Advocate having well established practive in delhi courts."
28 year old Hindu Kerala Iyer girl: "We are looking for an alliance for our elder daughter. She is an innocent divorcee with no encumbrance and her marriage was not consummated. She is very beautiful, fair, intelligent, god fearing, family oriented with traditional values. We are looking for professionally qualified & wellplaced Iyer boys preferably located at Bangalore, god fearing, caring and understanding and with respect for family values."
Fortunately, in addition to being great consumers of newsprint, they are also great recyclers, although not in the way you would imagine. Yesterday i left work and stopped at the large bicycle cart of a man selling bananas. I purchased my bananas and he pulled out a large perfectly torn section of newspaper and with it wrapped my bananas, using a string to tie it all up.. My next stop was the pharmacy: i left not two minutes later with a new bottle of face wash wrapped, you guessed it, in another perfectly torn piece of newspaper. Hungry for a snack i stopped at another street stall and picked up a samosa, wrapped in newspaper. On my way to my final stop, the laundry, i passed a seller of freshly roasted peanuts served in cones of newspaper. I picked up my two freshly pressed shirts, folded around appropriately sized and torn newspaper, and my trousers. All of it was folded and tucked in yet more newspaper. Had i not stopped them, all of these paper-wrapped items would have ended up inside a little plastic bag as well. One would be tempted to conclude that all of this newsprint exists to more neatly wrap up the other transactions of daily living.
So, what does this all have to do with medicine? Very little. But it has much to do with health, to which all these cultural idiosyncracies contribute.
Not an exciting day on the wards. Wish i'd had a newspaper to read.
justin
ps. The young boy with the liver failure, about whom i wrote yesterday, was both more alert and interactive today.
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