How Was India?

I know now that I am back, there will be many people wanting to ask me this question, and I've been thinking about how I can respond.  I really don't know how to answer it succinctly.   It was amazing.  But that doesn't really do it.  It was too many things to even get into in one conversation.  It was beautiful and sad and inspiring and discouraging and fun and challenging and thrilling and funny and awful and uplifting and difficult...


Was it what you expected?  In some ways yes, but mostly no.  I had envisioned doing heroic things, making strides for humanity and for the Lord.  Delivering babies with one hand and suturing wounds with the other; having profound conversations about God's love and mercy.  Well, maybe not quite as grand as all that but something like it.  And that's not exactly what happened.  I ran headfirst into so many limitations: the hospital's facilities, the peoples' perspectives, the health care system in India, the language barrier... but mostly my own limitations: the limits of my medical knowledge and skills, and the limits of my faith.  I began to re-examine why God had brought me there.  If I wasn't saving lives and saving souls what was I called there to do? 

There is, of course, the possibility that God is working in ways bigger than I can see.  That I did, in fact, make some difference in people's lives that I'll never really know.  And I have faith that that's true to some extent.  But I'm also beginning to suspect that maybe India didn't need me so much as I needed India.  That hospital was plugging along just fine before I came and they'll continue to carry on without me.  But I will not be the same.  There is something at work in me, so much that God wants me to learn from all this.  I have been so flooded with experiences that I haven't even begun to sort through them all yet.  It'll take months, at least, of personal debriefing and reflection to decipher out all the lessons God is trying to teach me.  Please pray He'll give me wisdom.


I didn't end up learning that much Hindi while I was there.  It's such a departure from the Germanic and Romance languages that I'm accustomed to that my ear doesn't even recognize some of those sounds.  I learned a few words, for hello, thank you, please, yes, no.  But the one sentence I did learn may be one of the best things that can be said, and I think kind of sums things up nicely...

"Jai masih ki"

Praise the Lord

Agra Trip

Finally home!  My bed is even more comfortable than I remember.


My last day in India, I made the trip to the city of Agra about a 3 1/2 hour drive from Delhi.  I hired a personal driver, Raj, who also served as my personal tour guide for the day.  Our first stop was Akbar's Tomb.

Entrance to Akbar's Tomb

Akbar was a Mughal emperor in the 1500's and is still well loved by the people of India.  His tomb is made of this beautiful red sandstone.  Shoes are removed before entering, and once through the entrance room, there is a long narrow tunnel that opens up into a huge cavernous vault.   In the center is Akbar's burial site.  A man stands next to the grave and greets visitors, and when I entered he extended a flower blossom to me, placed it in my hand, then put his hand on my head and said, "Long life," then gestured towards the grave.  Taking his cue, I placed the flower blossom on the grave, so I think I have now been blessed by Akbar.

Next we headed further into Agra and finally arrived at the gate to the Taj Mahal.  The line to get in wrapped back and forth in front of the entrance, and Raj had no intention of waiting so he said, "We go a secret way."  He lead me down an winding alleyway past little shops and fruit carts, then turned abruptly into a small doorway and up the steepest stairs ever constructed.  The stairway opened up into another alleyway, which we followed until all the sudden we were at a back gate to the Taj. There was almost no line, so we walked right in.  So nice to have someone who knows these little secrets.

After walking through the security gate, we see one of the 3 main gates to the Taj Mahal...

Gate to the Taj

Then, after walking through the gate, this...

 

It was amazing, so beautiful.  Made entirely of white marble.  It was really breath-taking. 

We walked up through the garden and then removed our shoes before walking up the solid marble steps to the entrance.  There are intricate carvings everywhere.  It's easy to see why this took 22 years to complete.  There are 4 rooms encircling the mausoleum at the center, and in the very middle, directly under the huge dome, is the grave of the emperor's wife with his grave right next to hers.

It's really a sweet story, the emperor building this incredible burial site for his wife who died in child-birth.  What's less sweet is how he chopped off the hands of every man who helped build it so they could never build another one like it.  Yikes.

We spent a while just marveling at the Taj, then had time for one more stop.  Near Agra is a town called

Vrindavan, the birth place of Krishna, one of the Hindu gods.  This is a very holy city to Hindus, and there are about 5,500 temples in this one area.  Followers of Krishna from around the world converge on this spot to worship and live.  Raj took me to one of the temples not too far off the highway.  We took our shoes off before going inside (they're big on this practice, as you can tell), and the first thing that hit me were the beautiful aromas inside.   To put it tactfully, India is not the most pleasantly fragrant place on earth, so after weeks of inhaling India-smell, the scents of flowers and incense were so gorgeous and refreshing.  The temple was beautiful.  Gold and marble and lush fabrics everywhere.  It was full of worshipers, some walking around admiring the alters, some kneeling to kiss the floor, many sitting on the floor in a group singing, chanting and playing instruments.  There were 3 alters to Krishna at the front.

Inside the Hindu temple

I was surprised how many white faces I saw in the temple.  Raj told me that for whatever reason, Krishna is a popular deity for Hindus in the West, and many Hindu Americans leave everything behind to come to this place.

Seeing the temple was a very complicated and emotional experience.  First I felt very uncomfortable, like it wasn't right for me to be there somehow.  Then, sadness.  I watched the people grovel and chant and sing and felt such love and such sadness for them.  They're so obviously searching and longing, but they're just missing it.  I admit that in the past I have toyed with the idea that all world religions are just grasping at the same thing; that we all worship the same God but just in different ways that are bound by the cultures in which we find ourselves.  Even if that's true, being in the Hindu temple really brought home to me that there is something that Christ gives that nothing else can provide.  I am nothing, but the Creator and King of the universe somehow loves me.  So much, in fact, that He took on this lowly dirty form of man and suffered, just so we could be reconciled to each other and be together.  What a deep and profound joy that is!  What a privilege it is to be able to have a personal relationship with the Almighty.  How unfathomable.  My heart breaks for those who are missing out on this.  I said a prayer for them and specifically for Raj as we left.

Saying Goodbye

Today Katie and I made another visit to Dehradun and went a little further into the city this time.  Now that I'm about to leave, I'm starting to feel like I'm getting the hang of a few things around here.  For example, today on our way to Dehradun an auto rickshaw wanted to charge us 150 rupees for a ride that I know should have cost about 10.  I'm sorry, I'm white but I'm not stupid.

I found a bank that would cash my traveler's checks (that was way more of a hassle than I expected it to be), then found a nice restaurant for lunch.  Still, even a nice restaurant only ended up costing us the equivalent of about $7 each.  It was just refreshing to have something besides rice, dal, and roti. 

After lunch, we found a McDonald's and just had to check it out.  If you had told me that we live in a world where there exists a McDonald's that doesn't serve hamburgers I might not have believed you before today.  Not a single hamburger on the entire menu.  Their "Big Mac" is called a "McVeggie," and it's a veggie burger.  I'm not making this up.  There was also something called a "Veggie Surprise," but I had no desire to discover what the surprise is.  Since we weren't feeling adventurous enough to try anything else on the menu, we each just got an ice cream cone and I can thankfully say that it tasted just like home.

We did a little more shopping, browsed the bazaar for a while, and headed back to Herbertpur.  Public transportation in India is always an adventure.  To get to Dehradun from Herbertpur, you have to first take a bus for about an hour, then a vikram for about half an hour.  A vikram is similar to an auto rickshaw in that it only has 3 wheels and no door on one side, but it's a little bit bigger and functions more like a bus than a taxi, having a specified route it travels and people jumping on and off.  A vikram really seats 6 people, but 8 and sometimes 9 are routinely crammed in.  I was the 8th person to squeeze into our vikram today, 9th if you count the child on her mother's lap, and I had to sit sideways and hang an arm out the window to fit.  The buses are equally crowded.  At one point the bus was so full that there was one person hanging out the open door, holding on only through an open window.  Fortunately, there were always a couple of gentlemen around to offer us their seats so we never had to stand too long.  We always attract conversation on the buses, people asking where we're from, what we're doing here, wanting to practice their English.  I tell all kinds of lies like "yes, I've been here quite a while... yes, my husband's here, too... yes, Katie's also married... My last name?  Simpson..."  I'm sure no one means any harm, but you never know.  The high school kids are always the most fun because they seem to be the most unashamedly fascinated and enthralled by us.  One girl told me today that I look like Maria Sharapova.  I don't know, we're both white and blonde...?

Tomorrow will be my last day in the hospital.  I'll work through the morning, then I'll leave for the train station in Dehradun at about 3:30 tomorrow afternoon.  I have so many mixed feelings about leaving.  On the one hand, I can't wait to get home and see Ryan, and take hot showers and sleep in my own comfortable bed and eat my normal food.  But on the other hand I feel like it's too soon to leave.  I just got here and I feel like I haven't done enough yet, haven't really made a difference yet.  There's so much need here, not only among the people we treat but also within the hospital itself; the doctors being so overworked, the facilities being so limited, so underfunded.  I feel like there's so much left to do.  I really hope that I was able to be of some help.

As tonight is my last night in the hospital, it will be my last blog post before I return home.  I'll arrive in Delhi late Tuesday night, then spend Wednesday on a trip to the Taj Mahal, then head to the airport late Wednesday night.  Once I get home I'll post my final adventures and reflections and finally upload some pictures.  Thank you so much for your prayers for my safe return.  I'll see you Stateside...

Isaiah 58:11

It was a beautiful day here today.  The monkeys seemed to notice, too, and they played outside the window during church this morning.  At the end of the service, the pastor announced to the congregation that I would be leaving this week, then invited me up to lead the closing prayer.  It took me a little off guard to be put on the spot like that, but I appreciated it and was grateful to be able to participate in that way.

This afternoon the hospital kicked off its cricket tournament, playing for the Herbertpur Christian Hospital Cup.  I sat and watched and tried to make some sense of what was going on.  There was a lot of yelling in Hindi, and a lot of laughing and cheering and clapping and pointing and gesturing, and I have no idea what any of it meant.  I made some comment about baseball to the Westerners around me, and Goli, the woman from Switzerland, said, "Isn't cricket basically the same thing?"  I don't know what kind of look I must have had on my face but before I could even respond she said, "Oh, sorry."

Nikki, the nurse from Washington state, left a couple of days ago.  But before she did, she, Katie and I got together and prayed with each other and for each other.  We prayed for each other's safety, and we prayed for trust and wisdom and strength.  Mostly we thanked God for bringing the 3 of us all here together at the same time.  He knew we would be here before we did, and He provided for our every need, even companionship.  One of the passages we read in church this morning was Isaiah 58:11... "The Lord will guide you always; He will satisfy your needs in a sun-scorched land and will strengthen your frame.  You will be like a well-watered garden, like a spring whose waters never fail."  How true that is, and how faithful He is.

Brunch

This morning I enjoyed a lovely brunch with some of the ladies of the hospital.

There is a Swiss couple here, both doctors, who are visiting for a couple of months with their two sons, ages 3 years and 18 months.  (The kids seem immune to culture shock and appear to feel right at home.  It's amazing.)  The husband and wife alternate days working in the hospital while the other stays home and watches the children.  The guest house where they are staying has a little garden in front, so when the Medical Director’s wife offered to make us all brunch, their garden seemed like the perfect spot.  Katie and I went over early to help Goli, the Swiss woman, bring a coffee table and chairs out into the sun, then the Director's wife, a doctor at the hospital herself, brought over pancakes made from scratch with honey.  Another doctor's wife was there, and she brought a south Indian dish called idli, which is a bread-type thing made out of rice and lentils and dipped in tomato chutney.  So yummy.  Fruit salad and Western coffee rounded out the meal.  The weather was perfect, sunny and warm.  The two Indian women brought their children, too, and all the kids, Indian and Swiss alike, played together on a blanket in the shade of a big tree.  Another woman we all knew happened to walk by, so she stopped to sit and chat and eat for a while.  It was really lovely.

Today is the first day of the World Cup of cricket.  It goes from now until the beginning of April, I think, and it's a huge deal here.  I walked up to Vikas Nagar to do some shopping this afternoon, and every shopkeeper had the game playing on his television.  The hospital is even having its own cricket tournament among the men on staff.  I feel like someone should tell them about baseball.

Mobile Clinic, Part 2

Today I went to another Mobile Clinic, a little further out than the one I visited before.  The drive out there is so beautiful.  The forests are so green, even in the winter.  And I thought the hospital was in a rural setting, but this place was really rural.  We worked to the sounds of goats bleating, and the jiggling of jingle bells on horses and the clip-clop of ox's hooves on the road as they pulled carts stacked with sticks, grasses, or mustard plants.  The clinic site was a small room detached from the home of a large multi-generational Muslim family, who allows the hospital to use their property once a week for our clinic.  The room had concrete walls and floor, and a tin roof held up by skinny logs.  The wall facing the street was partly made up of wire grating, and at around 2:00, after school let out, a large group of girls all dressed in matching school uniforms crowded around to peer inside at the white person.  I'm pretty fascinating. 

The family who loaned us the clinic site was very kind and gracious, and even served us all chi half way through the day.  The patriarch invited us back to see the large courtyard and stables where he kept several cows, a few goats, and a puppy that antagonized the goats.  One of his older daughters was pumping water from a pump to give to the cows.  The father led two of his younger children up to me and grinned at my camera.  I snapped a photo of the two of them and showed dad the image on the screen, and he gushed and smiled and thanked me.  I wish I had had a polaroid for him to keep. 

Last night was movie night.  Katie brought a few DVDs from home, and so last night she, Nikki and I huddled under a blanket in front of Katie's laptop and watched When Harry Met Sally.  So much fun.  A little taste of home.

Casualties

Today started out slow, but a little after 3pm Casualty got hectic. 

We had 2 patients with incredible pneumothoraces (collapsed lungs).  I've never seen chest x-rays that looked like these, even in text books.  The collapsed lung on both patients was about the size of a golf ball.  I took pictures of the films.  The most common cause of a pneumothorax in this area of course is TB, which seems to be the most common cause of a lot of medical aliments here.  So I spent part of my day restraining patients' flailing limbs while the doctor put in chest tubes.

One woman came in completely delirious, alternating back and forth between wailing in pain and singing.  She had fallen off her roof while she was hanging clothes out to dry, and the hematoma on her forehead made it pretty clear she had hit her head.  The hospital doesn't have a CT scanner, so we had to send her to the nearest town for a CT of her head, then she'll return here for treatment.  She has been seen at the hospital before: 6 months ago, when she gave birth to her son. 

Another man with either pneumonia or TB (not sure yet) came in with a O2 sat of 68% on room air.  Ideally, you'd like your O2 sat to be at 100%, or at least 93%.  He was in bad shape.  We admitted him to the ICU.

And one woman had nothing physically wrong at all that we could find.  She was complaining of generalized abdominal pain, and every time we asked exactly where the pain was she pointed to a different spot.  She also said her chest kind of hurt, her arms and legs kind of hurt...  I suspected it at first, but after all her tests and labs came back normal, I was pretty convinced this was entirely psychosomatic.  It's incredibly common here, even more so than in the States.  This is a culture in which neither men or women are expected to show emotions; they are a very stoic people.  All that suppression is bound to catch up with you eventually, and it usually manifests itself as very vague physical symptoms.  A pain here, an ache there, a loss of appetite.  This occurs in both genders, but seems to be harder on the women.  Nothing to do but reassure her that she's OK.  Let this be a lesson to us all: let it out, your body will thank you.

Familiar Faces, Food, and Chi

The couple's dinner on Sunday was a huge success.  The worship hall was decorated with heart-shaped balloons, streamers, hearts and flowers cut out of construction paper, and candles.  We had about 25 couples attend.  It was so much fun to see all the ladies dressed up in their beautiful saris.  We served a 3-course meal and the couples played some games, and at the end of the evening Katie and I announced the best-dressed winners.  After group photos, everyone joined hands and sang a song called "Bind Us Together, Lord."  It was great fun.

After spending every waking moment of my entire weekend on this party, though, I was exhausted.  So I asked if I could have Monday off, in part to catch up on some sleep and in part to try to get over this cold that's been nagging at me.  I already feel better today.

The campus has another American this week.  Nikki is a nurse just 2 years out of nursing school from Washington state, where she recently quit her job to come work in India for 6 months.  She's already been in India since November, and she's been traveling around from one EHA hospital to another and one community development project to another.  She'll just be at Herbertpur Christian Hospital for a week, but it's great to have her here.  Not only to have another "familiar face," (all Americans now seem to have familiar faces) but also because she's so knowledgeable since she's been here so long already.

The 3 of us - Katie, Nikki, and I - all walked up to Vikas Negar late this afternoon for some fruit shopping.  Oranges are a welcome treat to break up the monotony of the Mess food.  The Mess food isn't bad, it's just always the same.  There's always rice, there's always roti - India's version of tortillas - and there's always dal, which is like a thick soup composed mostly of beans or peas or lentils of some kind.  Every day, for both lunch and dinner.  The only thing that ever changes in the kind of dal they serve, but they only have about 3 or 4 different kinds in the rotation.  It's decent food, and I wouldn't mind having it one or twice a month, but every meal for 3 weeks is a bit much.  I shouldn't complain, since they're only charging me 60 rupees per day for food: about $1.50.

One thing I love and have not gotten tired of is the chi (tea).  They make it very sweet here, and you couldn't get a cup of black chi even if you wanted it because they mix cream, sugar, and honey into the entire pot.  It's excellent.  The hospital has a chi service that comes around twice a day - once in the mid-morning and once in mid-afternoon - so that all the doctors and staff can have their twice daily cup of chi.  No one ever misses chi no matter how busy it gets, even if it means having to drink it while seeing a patient.

I'm posted in the Casualty unit all this week.  I really like it.  The autonomy is so much fun.  Sometimes I'm the only one there resembling a doctor, so the nurses look to me to make decisions about the patients who roll in.  Fortunately, one of the 2 Casualty nurses is a seasoned veteran, so she has my back and makes sure I don't overlook anything obvious.

Just one more week left in the hospital.  Can't believe it's going by so fast.

Doctors-To-Be

Saturdays are just half days at the hospital, but even just a half day is plenty of time to run across something exciting.  We had 2 patients come into the Casualty unit with TB.  I've never seen chest x-rays look so dirty.  One patient has TB and has been smoking 3 packs a day for 20 years.  He's in bad shape.

One young patient came in referred from another outpatient center with severe headache, vomiting, and new-onset seizures.  He had gotten a CT at a stand-alone imaging center in town (we don't have CT machines here), and sure enough... Neurocysticercosis.  Unbelievable.  Neurocysticercosis is caused by a tapeworm found in bad pork, and it causes cysts in the brain which can be seen on a CT.  It's almost never seen in the States, but apparently it's quite common here.  This is one of those obscure diseases we learn about but never really expect to run into.  All the doctors here were so nonchalant about it since they see it all the time, but I was amazed.  Just another reason to avoid the meat here.

This week 2 pre-med girls from Delhi visited the hospital for an "exposure trip," I guess just to see what they were getting themselves into.  In India, medical students don't have to go to college; it's just straight from high school into med school, which is 5 years.  These 2 girls are both 19 and have finished with high school and are now taking a year off to study and prepare for med school's entrance exams.  They want to go to India's Christian Medical College and eventually serve the poor.  They're 19, but a very young 19, and knew so little about medicine (they had never heard of a C-section, for example).  They seemed quite overwhelmed and intimidated, so I tried my best to explain what was going on.  They called me "Dr. Angela."  When I asked what kind of doctors they wanted to be, one said, "My heart beats for psychiatry," so she became my favorite.  The two of them left today, but before they did they each gave me a note written on pages torn out from their journals thanking me for my help this week and wishing me blessings.  They each gave me a chocolate bar, too.  So sweet.  It warmed my heart.  It encourages me to see girls wanting to go into medicine here, where it is still very dominated by males, and it is especially encouraging to see an aspiring psychiatrist.  Please say a quick prayer for them for me.

I spent the entire afternoon getting decorations together for the couple's dinner tomorrow night, an there's still a lot to do tomorrow.  I think it'll be a success though.  If I don't get to post tomorrow it'll be because I'm busy with that, and the computer lab is closed on Mondays so it may be a couple of days before I can check in again.

Hope everyone is staying warm back home!

Pleural Marriages

Another full day.  This morning we saw 50 patients in 4 hours in the Ob/Gyn outpatient clinic.  I would do the exam on one patient while the doctor was talking to the next patient, then he would send her in to me for an exam, and bring the next one in.  Like a machine.  I will say I think I'm getting better at my prenatal exams with all this practice.  I was able to diagnose a breech today just by palpating.

This morning on rounds I was introduced to a patient who had just given birth and whose husband just died 2 months ago.  So sad.  In the tradition of the people that live in this area, though, she will marry her deceased husband's brother.  How very Biblical, right?  And if her deceased husband had more than one brother, as they often do since contraception is not commonly used, she will marry all of them.  This is a very common practice here.  One woman married to several different men, all brothers, who pass her back and forth and share her.  The result is a woman who is perpetually pregnant, and no one knows who the father is of any of her children.  It sounds dysfunctional, but I guess it works for them.  I think it's better than being a young widow.

On Sunday evening, the hospital church is putting on a dinner for all the married couples to celebrate Valentine's Day, and Katie and I were volunteered to help.  We just returned from town where we bought decorations, and we're going to spend this evening making the fellowship hall look festive.  We'll also help serve the dinner on Sunday, and Katie and I are to be the judges for the best-dressed competition.  The winning couple gets a nice dinner at a fancy restaurant in Dehradun.  Such fun!

So I'm off to do some decorating!

Busy

Today, the doctor I'm working with was covering both the Ob/Gyn service and the Casualty unit, so I spent the day running back and forth between prenatal exams, C-sections, and emergency evaluations.  Most of the day, though, was spent in Casualty, and I loved it.  There was cholecystitis, an upper respiratory tract infection, alcoholic cirrhosis, a femoral head fracture, a labial hematoma, metastatic cancer, seizures, a vertebral compression fracture, a DOA (dead on arrival)...  And a suicide attempt - ingestion of pesticide.  My mind was racing with questions I wanted to ask the patient for a full psychiatric evaluation, but not the time or the place.  He was kind of busy being decontaminated (since the toxic substance can remain on the clothes and skin).  He'll get a gastric lavage and some activated charcoal and then sent on his way.  Even if there were psychiatric services available here, the people here would never go for it.  It's a shame.  All he's learned is that he needs to take more pesticide next time.
The hospital is so short-staffed that I can function as a sort of baby doctor.  I can evaluate patients, write notes, order labs and radiological studies, and make recommendations.  I love the autonomy.  And it's so satisfying to feel that I'm actually being of some help.  The doctors here work 6 days a week, sometimes 7, and they're on call every 3 nights with no post-call day off.  They're perpetually exhausted.  It may be that my being here is just as much help to the doctors as it is the patients. 

As for me, I worked 12 busy hours today, and while that pales in comparison to the doctors' schedules, I'm still tired.  But it's so much fun.

Surgical Flip-Flops

I spent part of today working in "Casualty," which is what they call their ER, just doing some training and learning their system of doing things.  I hope to start working there more regularly next week.  I don't know of any statistics on this, but I just know the hospital's rate of infection must be sky high.  Everything here is dirty.  Gloves are not used for examining patients.  Sinks for hand-washing are scarce.  Not even any antibacterial gel anywhere.  It occurred to me today that I have probably been exposed to enough TB to turn my next PPD test positive. So that'll be fun to try to explain when I'm starting residency.

Another scary difference is that they operate in flip-flops.  As in, do surgery with toes completely exposed.  This is horrifying to me.  There are designated surgical flip-flops that everyone changes into when they change into scrubs to come into the OR.  The idea is that they don't want to get their own shoes dirty.  I don't know if the idea of shoe covers has never occurred to them, or if they can't afford to keep purchasing disposable shoe covers...  But we were taught NEVER to wear open-toed shoes in the hospital, much less in surgery.  What if someone drops a bloody scalpel?  What if the C-section is especially messy?  Yikes.  I was told in my orientation not to question how they do things here too much, because resources are very limited and they do the best they can with what they have.  I guess this is just one example.

Those who know me will not be surprised to learn I have made a canine friend.  There is a feral dog that lives on the hospital grounds.  The story goes, the dog was on death's door about a year ago, very sick, and the pastor of the hospital church took him in, cared for him, and nursed him back to health.  The dog has never forgotten it.  Each morning he comes into the waiting room of the hospital where we have morning devotional time and sits at the pastor's feet.  But somehow he knows he's not allowed in the hospital at any other time.  He will follow the pastor to church on Sundays and wait patiently outside until the service is over.  I can hear Ryan's voice telling me not to touch any stray dogs, so I won't, but I did take pictures.  His name is Foxy.

I hear another round of snow has hit Texas.  Can't say I miss it.  It's beautiful here.  Cold at night and in the mornings, but sunny and warm all afternoon.  I think I picked the perfect time of year to come to India.

I saw a quote today that said "A ship in the harbor is safe, but that is not what ships are built for."  I think I can safely say I am out at sea.

Mobile Clinic

A beautiful day in the Himalayan foothills!

Today I went to one of the hospital's "mobile clinics" located in a village several miles away.  A small group of us piled into a Jeep and drove for about 45 minutes along narrow, tight switchbacks up into the hills through beautiful forests filled with monkeys.  The clinic site is located in a small town on a dusty road, and the clinic itself is set up in a small courtyard behind one the shops.  There is a table and plastic chairs for consultation, and a bed made of wood and grasses for exams.  Common medications are stored in a locked shed and dispensed for free. 

One patient was an 8 year old girl with a swollen lymph node the size of a golf ball on the side of her neck.  Mumps.  I had never seen mumps before.  Not something we really have in the States, thanks to vaccines.  The girl  required no medications, as mumps is usually self-limiting.  She'll be fine in about a week.

There were several other patients that just couldn't be treated with the extremely limited facilities there.  One man came in complaining of chronic productive cough.  Here, chronic productive cough usually means TB, but we can't be sure without a sputum culture.  We gave him a referral card and urged him to come to the hospital, but it's doubtful that he will.  Herbertpur is so far away for him, and he just doesn't understand why it's so important.

On the way back to the hospital, we stopped by a home where a girl sells hand-made blankets.  She looked like she was in her late teens, early twenties, and she lives in small house with a thatched roof with her extended family.  Outside their home is a huge loom, which she demonstrated for us how to use.  She even makes her own thread and yarn out of old discarded fabrics.  As we were leaving she asked if I would stay.  What can I say, it must be the blonde hair.  Next time we go I'd like to buy something from her.

Tonight Katie and I walked to Vikas Nagar, a small town consisting basically of one long road lined with shops just a little up the road from the hospital.  One our way we ran into a wedding celebration.  We heard it before we could see it.  Drums beating, cheering, shouting, dancing in the streets.  The bride and groom were dressed in all kinds of beautiful adornments, and the getaway car was decorated with flowers.  The crowd saw Katie and me with our cameras in hand and begged us to take pictures.  We were happy to oblige. 
I've noticed many of the people here are delighted by having their picture taken.  One little girl, maybe 10 years old, came up to me and said in beautiful English, "Hello.  How are you?...Fine," then looked at my camera, grinning.  I snapped a photo of her and then showed her her picture on the camera, and she giggled and giggled.

So it looks like I'll be staying on the Ob/Gyn service throughout the rest of this week.  We'll see when I'll be able to rotate somewhere else.  Maybe next week.

Dehradun

This morning started off with a worship service that ended up lasting for 2 hours.  And Ryan says Baptists like to sing!  It was a nice service, though, half in English and Hindi.  The music was almost all in Hindi, but I still really enjoyed listening to it, especially with the accompaniment of the conga drums (I'm sure Indians have another name for them, but I don't know what it is).  We did sing one song in English, "What a Friend We Have in Jesus," and it brought me right back home.

Then Katie, the other American medical student, and I decided we'd take a trip into Dehradun, the closest large-ish city.  So we hopped on a bus for the hour-long trip.  The bus ride was fun, and it was one of those moments when I become acutely aware that I am in a very foreign foreign country.  The paint on the bus was lime-green and chipping everywhere, and some great Indian music was playing over the speakers.  I watched rural India pass by outside the window, and it seemed like these communities are just frozen in time, isolated from all modern advances.  Horses and donkeys are still used to pull carts stacked high with hay, sticks, and reeds, which will be sold to be used to make beds, furniture, and even homes.  And again, cows everywhere.

My favorite discovery of the day was on that bus ride on the way to Dehradun.  The first time I saw one I wasn't even sure I had seen correctly.  But then they were unmistakable: monkeys!  We passed through a wooded area and all along the side of the road were monkeys, walking, sitting, eating bits of food, sifting through trash, watching the bus go by.  There were even several babies walking behind their mothers.  I was completely blind-sided by this.  Cows, pigs, goats, dogs - all of these animals roaming the streets I was prepared for.  Monkeys were a happy surprise.

In Dehradun, we ambled through the markets and took in all that there was to see.  I learned quickly that you have to always be alert in Dehradun because something is constantly being thrust at you.  Cars and motorcycles come rolling by, aggressive merchants display their wares, and children tap your arm begging for money.  I caught quite a few stares from people; I think the blonde hair and very white skin must have been fascinating.  Children pointed, young people spoke what English they knew - "hello, ma'am!" - and one woman came right up to me, grinning, and poked my cheek with her finger.  I decided to find it all flattering.

When we got back to Herbertpur we stopped in the food market and picked up some fruit (only fruit that could be peeled, of course) and a couple of packages of cookies.  Indian people aren't as big on sweets as Americans are, and dessert is not really a concept here, so I'm very grateful to have cookies in my possession now.

It was a fun but tiring day, and I think I'll sleep well tonight.  Tomorrow I will probably start working in a different area of the hospital.  I'm excited to find out where that will be.

Psychiatric Care in India

Just a half day at the hospital today (Saturday).  I spent the morning watching surgeries and the afternoon reading and enjoying the nice weather.  It's so crazy to hear about all the snow back in Texas.  Stay warm!

Someone asked me today what field of medicine I was going into, and I have to admit I was a little embarrassed to say Psychiatry.  It just seems so useless here.  Not that it isn't needed - I'm told that the hospital sees a suicide almost every day (organophospate poisoning seems to be the method of choice).  But to put things in perspective...  Until recently only 14% of all babies born in India were delivered by some kind of skilled medical attendant.  That is slowly changing, not because women are becoming more educated, but because the government has instituted a program that will pay 1500 rupees (about $33) to any women below the poverty line if she comes to a hospital to deliver her baby.  In a place where women have to be bribed to come to the hospital when they're in labor, no one is going to seek medical help for depression.  And people here are superstitious enough about taking antibiotics much less antidepressants.  I guess it just gets back to the concept of conveying love.  Maybe that's all you can do.

I can't tell you how much I appreciate all of your comments and e-mails.  They are such a source of joy and strength for me, and they help me feel connected to home.  Thank you all so much for keeping me in your thoughts and prayers.

[By the way, I will unfortunately be unable to upload any more photos or videos during my trip, since my computer has finally died.  I can use the hospital's computer lab to post updates and send and receive e-mail, but no uploading anything.  Bummer.  It'll just have to wait till I get home.]

Adjustments

Finally starting to get to work in the hospital.  Today and yesterday I've been working on the Ob/Gyn service, seeing outpatients and observing some C-sections and other surgeries.  It's just such a different world here.  I was watching an ultrasound on a pregnant woman yesterday, and we discovered she was going to have twins.  I would have expected this to be exciting news for her, but when she was told she was going to be having 2 babies she looked devastated.  I found out that she has already had 3 children, and she has had to give up her eldest to be raised by her sister-in-law because she and her husband cannot afford to care for all 3 children.  And now this pregnancy brings 2 more.  You wonder why the couple doesn't consider some kind of permanent birth control.  It's not that it isn't available, they just don't know and don't understand.

If an prenatal ultrasound is done here, it is illegal for a doctor to reveal the sex of the baby before it is born.  Male children are much more highly regarded, and infanticide is a major problem with female babies.  It is very common for a women to terminate the pregnancy herself if she finds out it will be a girl.  A doctor that discloses the sex of a fetus will lose his license and spend 5 years in jail without bail, and the parent who finds out the baby's sex before delivery will be fined 50,000 rupees (almost $1100).  They're not kidding around.

I'm having to make a lot of adjustments here.  First, there are no showers... or bathtubs... or hot running water.  Only a bucket and a heating rod.  The heating rod is plugged in and suspended in a bucket of water, and in about 20-30 minutes you have hot water - assuming there are no power outages, which happen several times daily.  Once you've manage to get a bucket full of hot water, a smaller cup is used to pour the water to bathe with.  It's really not that bad, but it does make me question how necessary it really is to bathe every single day.

There is also no central heating.  Fortunately, the afternoons are quite comfortable, usually in the high 60s.  The nights, however, get very cold.  The blankets on the beds are very thick, though, and I can stay warm if I sleep in layers.

I'm slowly getting used to the food.  It's basically the Indian version of cafeteria food, but it's not bad.  I'm getting braver with the things I try, and I'm finding ways to help cut down on the spiciness by pairing spicy things with lots of rice and roti, which is basically a tortilla made with wheat flour.

So I'm slowly starting to get a little more comfortable here, day by day.  There's a lot to get used to.  But I just keep reminding myself of the reasons I came, and since I'm only here a short while I'm trying to do what I can while I'm here and take in as much as I can while I'm here.  I saw a quote by Mother Theresa yesterday that said, "Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty that the person who has nothing to eat."  So I'm trying to find ways to convey love without words, since I don't speak the patients' language.  Please help me pray that I will be able to be of some help here, and that God will continue to give me strength.

I miss you all! 

Culture Shock

Finally here!  I arrived in Delhi at about 1pm on Tuesday, local time.  My flight was delayed out of DFW so I missed the connecting flight in London.  The next flight to Delhi was 8 hours later, but the long layover did give me a chance to stop by and say hello to Parliament and Westminster Abbey.

Once I finally got to Delhi, Zarema, the coordinator for foreign medical student electives, picked me up from the airport and took me to a YWCA.  Nothing fancy, but adequate, and I got a private room and bathroom.  After getting settled, Zarema took me to the market to go shopping for Indian dresses, called “salwar kameezes.”  Pictures to follow. 

To and from the market, we took an auto rickshaw, which is a 3-wheeled golf cart-type vehicle that is cheaper than a taxi.  Auto rickshaws have no doors, and instead of being controlled with a steering wheel they have what looks like motorcycle handlebars.  Driving in Delhi is every man for himself.  Lane markings are suggestions at best, and cars travel mere inches away from each other.  Cars squeeze 4-wide on streets that are supposed to be 3 lanes, and even then motorcycles still whiz by around the edges.  When traffic does come to a stop, young girls selling flowers weave barefoot in between the cars looking for buyers.  Car horns are used liberally here, and not with aggression like in the U.S. but out of politeness, to let the car ahead of you know you are approaching.  Larger commercial vehicles even have written across the back “Horn Please.”  The result is constant honking from all directions.

I got up early this morning to catch the train to Dehradun.  When I arrived at the train station, a porter approached the car and we negotiated a price for him to carry my bag to the platform and load it onto the train.  The porters carry the bags on top of their heads, and some that I saw were even carrying 2 bags stacked on top of each other.  Like everything in India, the train cars adhere to a caste system.  As a foreigner, I am outside this system and do not belong to any particular caste, but the amount of money I am able to pay for a train ticket defaults me to an upper caste.  My train car was air conditioned with plush seats, and every traveler had a cell phone and an MP3 player.  In the lower caste cars, many travelers did not even have shoes.

The 6-hour train ride to Dehradun allowed me to see quite a bit of India.  The poverty is impossible to imagine, and almost too much to even take in.  The slums stretch for miles, many with only a tarp or large cloth for a roof.  Cows roam freely in the streets, and wild dogs and pigs sniff through endless piles of trash looking for bits of food.  In the fields and even by the train tracks people squat to defecate, with a large water bottle in hand to clean themselves (the left hand is reserved for this task, which is why Indians eat only with the right hand).  I had read about all of this before coming here but it was still shocking to actually see.

An employee of the hospital was waiting to meet me at the train station when I arrived in Dehradun, and we drove together to the hospital in Herbertpur about an hour away.  The hospital is a large campus with a separate gated residential area when the doctors, nurses and staff live.  There are about 100 inpatient beds as well as several general and specialty outpatient clinics.  There is another American medical student here, Kathryn, who has already been here for a week.  I will meet her tomorrow and work with her on the Internal Medicine team. 

For now, it’s almost time for dinner, so I’ll be headed to the cafeteria soon.  I’m feeling tired and a little home sick, but I think a good night’s sleep will make a world of difference.  I posted a few pictures, with more to come.  I'm having trouble posting videos right now, but I'll work on it.  Thank you for keeping me in your prayers.