As of 2001 more that 70% of Indians resided in rural areas. They are, however usually ignored. When foreigners think of India they think of Bollywood, the Taj Mahal, and big bustling Bombay. Very rarely will a foreigner’s mind venture into rural India and even more rarely will their bodies venture that far. When I was introduced to a small town near Aurangabad, of 450 people, they were told that there exists another country far away that is called Australia and that there guest has come from there to meet them. In this post I just want to describe how most Indian’s live, it may change the way you view this country.
Every morning the family wakes up with the sunrise. They have a calendar so that they know when to celebrate culturally significant days but most of the time they don’t know what the day or date is because it’s irrelevant. All houses are built with a small front porch, so after waking up the women sweep the porch clean and then spread cow dung along the floor. When it dries they put on a pot of tea. Meanwhile they take their set of brightly colored powders and draw a colorful design on the street outside the front door. This design is called a rangoli, and a woman of every house draws a different one every day in the morning. They can often all be seen doing it at the same time. Once the tea is ready the family will sit and have their morning cup on the front porch and then the men will head off to the farms to work. The women sometimes head off with the men or they stay back to do some cooking and join the men later. In any case they make sure that lunch is cooked and ready before the men come back. In the village where I went, Pofrla, there is a school and every child goes to school six days a week. However, this facility is not available everywhere.
They usually have baths in the morning before work but in the winter months an afternoon bath is preferred. The method is simple. You jump in a well, or if you’re a kid, or if you’re scared you get thrown into a well by someone bigger. There are usually several wells in each town, at least one for each landowner and each one is at least 7 meters in diameter so their big enough for more than one family at the same time.
The morning poo presents with an interesting problem. The government of India has tried to build a toilet in every village. Sometimes it doesn’t work, but when it does it means that there is one toilet for 450 people. I was told that in many villages the morning dump is traditionally done on the street outside your front door, not far from the rangoli. The rangoli, by the way is meant to welcome guests, what is the poo supposed to do? But thankfully in Pofrla there’s a hill close by so all the men and some of the women climb the hill and do their business n a secluded spot.
Work is hard. There are no machines to help out on the farm so all the work has to be done by hand or by bullock. When I visited it was winter and I was having trouble tolerating the heat. I find it difficult to imagine what summer must be like.
In Pofrla the main crop is cotton, but all the vegetables used for cooking are also grown. The village is almost completely self-sufficient, what little income they get from selling their cotton is saved and later spent on clothes or technology or healthcare. There is one TV in the village. It has two channels, one of which most villages will not understand because it’s in Hindi. Each farm has its own farm and the size of the farm often reflects the financial position of the family. However, anyone from within the town can take the vegetables from another’s farm, and when the cotton is to be sold it is all heaped together and sold as one lot. Everything important is shared, and ownership although individual in theory almost becomes collective as a result of sharing.
However, despite the apparent abundance of vegetables, their diet is poor. It usually consists of dhal, rice and bread, with some chilies for taste. As a result a very large proportion of the women are anemic and many of the children are malnourished. Note that this is a consequence of their lack of education and not of their poverty.
When the men come home in the evening dinner is waiting for them and the whole family eats together. Following dinner, the women wash up and then there is free time. The family often sits and talks, and people venture into each other’s porches to shoot the breeze. They compare their gains from the harvest, they talk about cotton prices, they gossip about new marriages or births and they talk politics. Every Indian no matter how poor or how divorced from a big city seems interested in politics. It is the antithesis of the apathetic public of most western countries.
Electricity exists but only flows for about 12 hours a day, and it comes and goes at will. If there are electric lights they may stay up and tell stories, if there aren’t then its bed time. They wake up the next morning to do it all again.
Their life is simple. Its hard work but at the same time with such a tight knit community I reckon it would be fun as well. The villagers told me that even when they go to the next village they feel uncomfortable, they are away from their families and friends and everyone they know and suddenly their strong and warm safety net does not exist. Bu at the same time, for a youth, the whole town can be explored in half an hour, there is not much new to learn, and if you don’t like farming, well… you have to be a farmer anyway.
Monday, December 7, 2009
The poorest of the poor
Last week while working in our urban slum clinic the social worker suggested that we visit the poorer side of the slum district.
There are two broad types of slums, authorized and unauthorized. The slum that I work in is authorized. It‘s been there for more than 25 years and is a well established community with permanent brick houses etc. But it began its life as an unauthorized slum. I’m not sure of its history exactly, but it usually goes something like this. On some patch of unused land, usually government land, but sometimes private, somebody puts a statue of a respected person or a flag representing something of cultural significance. An example is a statue of B. Ambedker; he crafted India’s constitution and is almost worshiped like a god here. Once the statue is there people will not move it or take it away without incurring the wroth of the masses who will conveniently be outraged by such sacrilege and may go so far as to riot. In order to avoid this, the statue remains. A few weeks later a tent arrives and then another. They get cleared by the police but the next day instead of two there are five. As it grows some people closest to the statue build a house with bricks. It gets knocked down. Where there was one, now there are five. Someone dies. Their land, still unauthorized, goes up for sale on the black market. The mafia is often in charge and they control the buying and selling of property. In order to make some extra cash they sell the same plot of land to three poor families. When it’s time to move in the family realizes that someone else is already living there. A fight breaks out. The strongest family gets the house, the others get the street, their life savings already handed over to the mob.
Eventually the number of people living in the slum grows large enough to create some political gravity. Politicians are forced to accept the slum, or risk being voted out at the next election. The slum becomes authorized.
On the poorer side of mukundwadi the slum is authorized but the people mostly live in tents. I met a woman who was hanging her clothes out to dry. I wanted to talk to her about her health. I asked her ‘with regards to healthcare, what do you feel you are in need of? How are the available services falling short? And what do you think can be done to improve them?’ Being completely naive and inexperienced in the poverty department I naturally expected a long drawn out answer full of complaints and suggestions. I wanted her to tell me about all the problems they had with their health and how difficult it was to get to a hospital or see a doctor. But that wasn’t her answer. Her answer was that she didn’t know and she didn’t know because she didn’t understand the question.
There was nothing wrong with my Marathi, my questions all made perfect sense. So what was the problem?
The woman I talked to has lived her entire life in the now. Her only concern ever, was that she had two rupees in her pocket for food. She told me that she wakes up every morning hungry. If she has money she goes and buys food, if she doesn’t, she goes and finds some way to make money, usually by begging. If she is able to make two rupees she eats, if she doesn’t she starves. She never went to school, she has no idea how old she is, she has four sons and two daughters but she doesn’t know where they are. So ultimately the problem was that after a lifetime of brutal reality, she was never able to develop the ability to think in the hypothetical. She literally cannot suggest improvements in health-care because she does not have the mental capacity to imagine them. This is a perspective of poverty that I had not realized, and it means that the consequences of poverty are far more insidious that I had previously thought. Poverty does not only diminish your physical and material well-being, but a lack of education and a lack of varied life experience starves your mind.
There are two broad types of slums, authorized and unauthorized. The slum that I work in is authorized. It‘s been there for more than 25 years and is a well established community with permanent brick houses etc. But it began its life as an unauthorized slum. I’m not sure of its history exactly, but it usually goes something like this. On some patch of unused land, usually government land, but sometimes private, somebody puts a statue of a respected person or a flag representing something of cultural significance. An example is a statue of B. Ambedker; he crafted India’s constitution and is almost worshiped like a god here. Once the statue is there people will not move it or take it away without incurring the wroth of the masses who will conveniently be outraged by such sacrilege and may go so far as to riot. In order to avoid this, the statue remains. A few weeks later a tent arrives and then another. They get cleared by the police but the next day instead of two there are five. As it grows some people closest to the statue build a house with bricks. It gets knocked down. Where there was one, now there are five. Someone dies. Their land, still unauthorized, goes up for sale on the black market. The mafia is often in charge and they control the buying and selling of property. In order to make some extra cash they sell the same plot of land to three poor families. When it’s time to move in the family realizes that someone else is already living there. A fight breaks out. The strongest family gets the house, the others get the street, their life savings already handed over to the mob.
Eventually the number of people living in the slum grows large enough to create some political gravity. Politicians are forced to accept the slum, or risk being voted out at the next election. The slum becomes authorized.
On the poorer side of mukundwadi the slum is authorized but the people mostly live in tents. I met a woman who was hanging her clothes out to dry. I wanted to talk to her about her health. I asked her ‘with regards to healthcare, what do you feel you are in need of? How are the available services falling short? And what do you think can be done to improve them?’ Being completely naive and inexperienced in the poverty department I naturally expected a long drawn out answer full of complaints and suggestions. I wanted her to tell me about all the problems they had with their health and how difficult it was to get to a hospital or see a doctor. But that wasn’t her answer. Her answer was that she didn’t know and she didn’t know because she didn’t understand the question.
There was nothing wrong with my Marathi, my questions all made perfect sense. So what was the problem?
The woman I talked to has lived her entire life in the now. Her only concern ever, was that she had two rupees in her pocket for food. She told me that she wakes up every morning hungry. If she has money she goes and buys food, if she doesn’t, she goes and finds some way to make money, usually by begging. If she is able to make two rupees she eats, if she doesn’t she starves. She never went to school, she has no idea how old she is, she has four sons and two daughters but she doesn’t know where they are. So ultimately the problem was that after a lifetime of brutal reality, she was never able to develop the ability to think in the hypothetical. She literally cannot suggest improvements in health-care because she does not have the mental capacity to imagine them. This is a perspective of poverty that I had not realized, and it means that the consequences of poverty are far more insidious that I had previously thought. Poverty does not only diminish your physical and material well-being, but a lack of education and a lack of varied life experience starves your mind.
Thursday, December 3, 2009
Ajanta
The security guard at my hospital, a nurse, a ward boy, two doctors and a friend of a friend had all offered on separate occasions to take me to the Ajanta caves. Even people I barely knew or met for the first time would say “Wait till Wednesday, I have a day off, we can go together”. I wasn’t sure whether it was because they were being super kind or I was extra charming, but I wanted to go on my own. So I did.
The Ajanta caves were built between around 200 BC and 450AD by many successive generations of Buddhist monks under the patronage of both Buddhist and Hindu kings. Around 450AD the caves began to fall into disrepair and were slowly forgotten. For 1300 years they remained lost, the jungle slowly grew over them until they were eventually completely submerged under forest, mud and water. In 1819 a British hunter, hot on the trail of a tiger, stumbled across the very top of Cave Ten. He carved his name on its wall and began to slowly unveil the work of a lost civilization.
When I think of how he must have felt I am reminded of Leonardo da Vinci. In the early 1500’s he noticed that the fossils of sea creatures could be found where there was definitely no sea; on mountains, and far inland. Conventional wisdom held that the creatures must have somehow made their way there or that they were brought there. Maybe they were put there by god in order to test our faith in him (This, by the way, is the argument that the intelligent design museum in Kentucky gives for the existence of dinosaur fossils). However, none of these explanations satisfied him. So he pondered. Maybe at different stages in history, sea levels were at different levels. Maybe they rise and fell, and each time they did they delineated the beginning of a new age. Maybe the civilization of man prospered in each age but was wiped out every time sea levels rose. Could it be that in a previous age someone had made this exact same discovery and reached the same conclusion? That we are part of an infinite cycle? A wheel of time?
Unfortunately, even though it would be way cool, none of this is true; but Leonardo or the guy that discovered the caves didn’t know that. When he stumbled across cave ten he was looking into a lost age. The immense scale and beauty of the caves far surpassed anything the British had constructed at the time, so how could such an opulent and prosperous civilization die, and on top of that how could it be forgotten?
When I visited there was some restoration work in progress but unfortunately since their rediscovery they have lost much of their original luster. Ajanta is famous not for its rock carvings, which are themselves impressive, but rather for its mural paintings which cover the walls and columns of every cave. They reflect the culture of the day and the dreams of the monks that painted them. When trying to understand the paintings I thought it was amazing how little has changed in 2500 years. We still wear the same style of thongs in India, we still drink alcohol, we still marvel at the beauty of women, some of us still believe in an afterlife, and we still every day are confronted by the problem or whether to take the difficult but good path or the easy expedient one.
After about 4 hours of looking at them on my own I decided to hire a guide for about 100 rupees and I asked him back to back questions for about 3 hours. We were disturbed only by the pesky sunset which forced me to head back home. I’m glad I went but I can’t help but feel that it conflicted somehow with my goal to not be a tourist.
I’ve been taking the state transport bus everywhere but on the way home it was crowded Indian style. Three to a seat with people sitting on top of each other everywhere except for on the driver. I had an urge to take out my camera and take a photo. Nowhere had I ever seen a bus that full, especially a long distance one (I had to stand for 100 km= 3hours). But I suppressed the urge. I didn’t want everyone to think that I was an outsider. I was by that stage growing tired of the looks and stares associated with that label. I can only imagine how the white guy sitting near the front must have felt.
The Ajanta caves were built between around 200 BC and 450AD by many successive generations of Buddhist monks under the patronage of both Buddhist and Hindu kings. Around 450AD the caves began to fall into disrepair and were slowly forgotten. For 1300 years they remained lost, the jungle slowly grew over them until they were eventually completely submerged under forest, mud and water. In 1819 a British hunter, hot on the trail of a tiger, stumbled across the very top of Cave Ten. He carved his name on its wall and began to slowly unveil the work of a lost civilization.
When I think of how he must have felt I am reminded of Leonardo da Vinci. In the early 1500’s he noticed that the fossils of sea creatures could be found where there was definitely no sea; on mountains, and far inland. Conventional wisdom held that the creatures must have somehow made their way there or that they were brought there. Maybe they were put there by god in order to test our faith in him (This, by the way, is the argument that the intelligent design museum in Kentucky gives for the existence of dinosaur fossils). However, none of these explanations satisfied him. So he pondered. Maybe at different stages in history, sea levels were at different levels. Maybe they rise and fell, and each time they did they delineated the beginning of a new age. Maybe the civilization of man prospered in each age but was wiped out every time sea levels rose. Could it be that in a previous age someone had made this exact same discovery and reached the same conclusion? That we are part of an infinite cycle? A wheel of time?
Unfortunately, even though it would be way cool, none of this is true; but Leonardo or the guy that discovered the caves didn’t know that. When he stumbled across cave ten he was looking into a lost age. The immense scale and beauty of the caves far surpassed anything the British had constructed at the time, so how could such an opulent and prosperous civilization die, and on top of that how could it be forgotten?
When I visited there was some restoration work in progress but unfortunately since their rediscovery they have lost much of their original luster. Ajanta is famous not for its rock carvings, which are themselves impressive, but rather for its mural paintings which cover the walls and columns of every cave. They reflect the culture of the day and the dreams of the monks that painted them. When trying to understand the paintings I thought it was amazing how little has changed in 2500 years. We still wear the same style of thongs in India, we still drink alcohol, we still marvel at the beauty of women, some of us still believe in an afterlife, and we still every day are confronted by the problem or whether to take the difficult but good path or the easy expedient one.
After about 4 hours of looking at them on my own I decided to hire a guide for about 100 rupees and I asked him back to back questions for about 3 hours. We were disturbed only by the pesky sunset which forced me to head back home. I’m glad I went but I can’t help but feel that it conflicted somehow with my goal to not be a tourist.
I’ve been taking the state transport bus everywhere but on the way home it was crowded Indian style. Three to a seat with people sitting on top of each other everywhere except for on the driver. I had an urge to take out my camera and take a photo. Nowhere had I ever seen a bus that full, especially a long distance one (I had to stand for 100 km= 3hours). But I suppressed the urge. I didn’t want everyone to think that I was an outsider. I was by that stage growing tired of the looks and stares associated with that label. I can only imagine how the white guy sitting near the front must have felt.
Meeting Foreigners in Aurangabad
I came to India with the explicit intention of becoming Indian. When one travels we’re obviously exposed to a culture and a society that differs from the one that we’re used to. During that exposure we have two choices, view the culture through a closed window, site see, take pictures, and be a tourist; or absorb the culture, become the culture and learn far more than otherwise possible. The second method takes longer and is harder work but in the end is far more rewarding.
When I lived in Canada, about three months after staying near Vancouver I was walking down the main street when a tourist stopped me and asked me for directions. He wanted to know where the Orpheum theatre was. I put on the best Canadian accent I could muster and told him it was on the corner of Smithe and Seymour. Then I told him exactly how to get there, which bus number to catch and where to get off. I had become Canadian. Sure I hadn’t grown up watching Hockey Night in Canada, I hadn’t ever listened to the tragically hip and deep down inside I didn’t wish I was American (=-p), but I was no longer a visitor. I felt like a resident.
The same moment occurred last week when I met two Australian friends of mine in Aurangabad. They were on elective as well in a nearby town and had stopped by the city on their way to see the Ajunta caves. When I met them for dinner I was with two doctor friends of mine; we turned up late on our motor bikes Indian style and went to a tandoori restaurant for dinner. Compared to me, they were now the outsiders, and compared to them I was an insider. I was probably showing off a bit but I was happy to showcase my Marathi when speaking to the waiter, I told them about Indian culture and complained that the food was no where near spicy enough. I had become Indian. I mean, I was always Indian but now I had become Indian Indian.
An unfortunate consequence of becoming a local however, is that I have taken almost zero photos. I never take photos in Sydney because it’s my home. I can see it whenever I want and plus I don’t want to be mistaken for a pesky tourist. So why should I take photo’s in Maharashtra, after all I am Marathi. Plus I’ve been spending most of my time in the hospital and it doesn’t really seem ethical to take pictures there. “Your CT scan indicates that you probably have tuberculosis. Say CHEEEEESE”.
When I lived in Canada, about three months after staying near Vancouver I was walking down the main street when a tourist stopped me and asked me for directions. He wanted to know where the Orpheum theatre was. I put on the best Canadian accent I could muster and told him it was on the corner of Smithe and Seymour. Then I told him exactly how to get there, which bus number to catch and where to get off. I had become Canadian. Sure I hadn’t grown up watching Hockey Night in Canada, I hadn’t ever listened to the tragically hip and deep down inside I didn’t wish I was American (=-p), but I was no longer a visitor. I felt like a resident.
The same moment occurred last week when I met two Australian friends of mine in Aurangabad. They were on elective as well in a nearby town and had stopped by the city on their way to see the Ajunta caves. When I met them for dinner I was with two doctor friends of mine; we turned up late on our motor bikes Indian style and went to a tandoori restaurant for dinner. Compared to me, they were now the outsiders, and compared to them I was an insider. I was probably showing off a bit but I was happy to showcase my Marathi when speaking to the waiter, I told them about Indian culture and complained that the food was no where near spicy enough. I had become Indian. I mean, I was always Indian but now I had become Indian Indian.
An unfortunate consequence of becoming a local however, is that I have taken almost zero photos. I never take photos in Sydney because it’s my home. I can see it whenever I want and plus I don’t want to be mistaken for a pesky tourist. So why should I take photo’s in Maharashtra, after all I am Marathi. Plus I’ve been spending most of my time in the hospital and it doesn’t really seem ethical to take pictures there. “Your CT scan indicates that you probably have tuberculosis. Say CHEEEEESE”.
Wednesday, November 25, 2009
Anita
In the state of Maharashrta in the country India there is a town called Aurangabad. In the town of Aurangabad there’s a community called Mukundwadi and within Mukundwadi lives a woman called Anita.
Anita is different. She doesn’t conform to an outsider’s expectations of an Indian. Yet she is Indian. She doesn’t conform to the norms of her community, yet she is respected by it. And most importantly she does not live within the four walls identified with womanhood, yet she is still a woman.
Anita comes from a poor cobbler family that belongs to what is sometimes callously referred to as the untouchable cast. She started her education at five like any other child, but at the age of 14 she hit a roadblock. She had her first epileptic fit. She fell down and hurt herself badly on the way to school.
Epilepsy has an incredible social stigma in India, especially amongst the uneducated, and perhaps for her safety or for some other reason that we can not relate to, she was kept home from school. For two years she languished, un-stimulated, growing physically but not mentally. Waiting, like most other women her age to be married off to a husband that would take her off her parents’ hands for whatever meager dowry they could afford. But she knew her education was important; it remained in the back of her mind.
She approached a local social worker and started some drawing and tailoring classes. I spoke to the social worker and he said that the first time she came to see him she could barely bring herself to look up from the floor into his eyes or even to bare her face. After showing some promise she was asked to teach a class to younger girls. She refused. How could an uneducated epileptic untouchable girl ever teach anything? But her parents encouraged her and with the social workers support she taught. And she taught well.
Girls’ education is not a priority for most parents in the community. In fact a girl leaving their four walls after school hours is an uncommon event, but she knew its importance, and with her insistence, with her zeal, the students came. The taught tailoring and drawing to city girls and rural girls; and along with their new skills she taught them confidence. With boys on every street corner, most girls and their parents are fearful. What will they do? What will they say?
Anita now works a short bus ride and walk away from home. She sometimes walks with other women, sometimes alone. Every day she sees boys hanging around and on one occasion they started harassing her and her friends. She stayed quiet to see where it would lead. The boys kept teasing. The girls said nothing. She stepped up.
“Are you talking to me?” They boy was caught off guard. “Are you talking to me?” She hadn’t seen Taxi Driver. I asked. The boy stepped off. “Next time, make sure you know who you’re talking to” She told me she was prepared to slap him in the face if he talked back.
The transformation was complete. Anita has knocked down all four walls and has become free. She is seen and respected by all and is an example to all aspiring independent woman. That she exists is impressive, but that she exists despite being an unschooled epileptic untouchable is astonishing.
Anita is different. She doesn’t conform to an outsider’s expectations of an Indian. Yet she is Indian. She doesn’t conform to the norms of her community, yet she is respected by it. And most importantly she does not live within the four walls identified with womanhood, yet she is still a woman.
Anita comes from a poor cobbler family that belongs to what is sometimes callously referred to as the untouchable cast. She started her education at five like any other child, but at the age of 14 she hit a roadblock. She had her first epileptic fit. She fell down and hurt herself badly on the way to school.
Epilepsy has an incredible social stigma in India, especially amongst the uneducated, and perhaps for her safety or for some other reason that we can not relate to, she was kept home from school. For two years she languished, un-stimulated, growing physically but not mentally. Waiting, like most other women her age to be married off to a husband that would take her off her parents’ hands for whatever meager dowry they could afford. But she knew her education was important; it remained in the back of her mind.
She approached a local social worker and started some drawing and tailoring classes. I spoke to the social worker and he said that the first time she came to see him she could barely bring herself to look up from the floor into his eyes or even to bare her face. After showing some promise she was asked to teach a class to younger girls. She refused. How could an uneducated epileptic untouchable girl ever teach anything? But her parents encouraged her and with the social workers support she taught. And she taught well.
Girls’ education is not a priority for most parents in the community. In fact a girl leaving their four walls after school hours is an uncommon event, but she knew its importance, and with her insistence, with her zeal, the students came. The taught tailoring and drawing to city girls and rural girls; and along with their new skills she taught them confidence. With boys on every street corner, most girls and their parents are fearful. What will they do? What will they say?
Anita now works a short bus ride and walk away from home. She sometimes walks with other women, sometimes alone. Every day she sees boys hanging around and on one occasion they started harassing her and her friends. She stayed quiet to see where it would lead. The boys kept teasing. The girls said nothing. She stepped up.
“Are you talking to me?” They boy was caught off guard. “Are you talking to me?” She hadn’t seen Taxi Driver. I asked. The boy stepped off. “Next time, make sure you know who you’re talking to” She told me she was prepared to slap him in the face if he talked back.
The transformation was complete. Anita has knocked down all four walls and has become free. She is seen and respected by all and is an example to all aspiring independent woman. That she exists is impressive, but that she exists despite being an unschooled epileptic untouchable is astonishing.
Unbalanced.
I’ve come to India with an open mind. Having grown up in an Indian family there are many things about the country and the culture that I already knew, but India is so entirely different that only now am I realizing how little that was. The country and the culture, like any, has its successes and failures but curiously Indians seem only to acknowledge one side.
Any one who feels the need to mount a vigorous defense or to loudly sing their own praises only does so because they feel threatened in some way. Unless threatened, no matter how strong or intelligent or rich or powerful you may be, flaunting it is a waste of time. Almost all Indians I’ve met both here and abroad love their country, but here that love takes on a very unusual character.
When George Bush went to war with Saddam Hussein, John Howard said that we had to support America because they are our friend. But if someone is making a mistake, a real friend does not just go along with it; they point it out.
There are a few issues in which most Indians will admit fault. Corruption is a key example. People have such little faith in anything government related here because they just assume that it’s been corrupted; be it hospitals, schools, the bureaucracy, police etc. The population is another pet complaint. But beyond this, a criticism of anything Indian is very easily taken in offence.
It’s very likely that by reading this, my Indian friends will be offended too. But if they are, then they’re in a bit of a jam aren’t they? Because if they admit that they’re offended then they will be proving my very point; that Indians are not sufficiently self critical, and that their views are unbalanced. Muhahaha
A key part of Indian culture is respect for your elders. It is unfortunate that many Australians do not share this value and as a result some elderly people languish unvisited and uncared for in homes across the country. But in India, you find the other extreme. Respect for elders and for authority has created an extremely hierarchical society in which you must call everyone sir or madam. The younger doctors in the hospital where I work are all literally scared of the consultants. If they want to ask a question they do it with so much apology, that every time they do, I’m reminded of Oliver asking “Please sir, may I have some more?” and the consultant replies “MOORRREEE!?!?!?”.
A similar situation exists between children and their parents, where a child will treat their parent’s instructions like the word of god, without question or argument. That’s not to say that the children are unhappy, most feel that their parents know best so it is wise to do as they say. Keep in mind that most parents here will choose their children’s spouses when they are of marrying age.
So? You ask. If both children and parents are happy with the arrangement then what’s the problem? I’ll tell you. This relationship creates an extremely stagnant (Indians would call it stable) social environment. You would be hard pressed to find a culture less open to change and growth. Children do what their parents tell them, and then they get married to who their parents choose, and then instruct their kids the only way they know how, the way their parents taught them.
When talking about arranged marriage, a balanced person would admit that there are many advantages. Some would say that they are more stable and thus, are better for the children. I was part of an interesting conversation yesterday with a girl whose marriage had recently been decided, and her parents. Not long into the conversation however, it became more of a lecture about the faults of western morals and ideals in relation to family values and the far more superior Indian ideals. The high divorce rate was cited as a clear point of evidence, and it was followed by the ridiculous assertion that divorce is just as available to an unhappy Indian spouse as it is to a western spouse. Its disadvantages were glossed over or ignored. Following a tradition blindly and not seeing both its costs and benefits is the very archaic mindset that this country will have to overcome if it wants to improve the standard of living of its people.
Some other unwelcome criticisms that I have are regarding the treatment of women. Tradition and what I consider the extremist social conservative views of many Indians are again to blame. My hospital does a fantastic job of empowering women, but even within it I see sexism. I get my lunch and dinner provided and delivered every day for a minimal fee. Most single people here do the same. When I ask the male married doctors however they say, “Why would I get my meals delivered? I’m married”. It is implied that their wife will cook for them. Many women will not leave the house on their own because they are genuinely scared about what boys will do to them. When confronted about these issues most brush it off. Some have the gall to suggest that thousands of years of tradition have created this culture and so it must be right. Others have the belief that all of these ills are related to the invasion of outsiders and their exploitative ways. Capitalism. OWN YOUR MISTAKES.
India has done so many things in its past to be proud of, but until its people adopt a more balanced view India’s rise will always remain firmly in its future.
Any one who feels the need to mount a vigorous defense or to loudly sing their own praises only does so because they feel threatened in some way. Unless threatened, no matter how strong or intelligent or rich or powerful you may be, flaunting it is a waste of time. Almost all Indians I’ve met both here and abroad love their country, but here that love takes on a very unusual character.
When George Bush went to war with Saddam Hussein, John Howard said that we had to support America because they are our friend. But if someone is making a mistake, a real friend does not just go along with it; they point it out.
There are a few issues in which most Indians will admit fault. Corruption is a key example. People have such little faith in anything government related here because they just assume that it’s been corrupted; be it hospitals, schools, the bureaucracy, police etc. The population is another pet complaint. But beyond this, a criticism of anything Indian is very easily taken in offence.
It’s very likely that by reading this, my Indian friends will be offended too. But if they are, then they’re in a bit of a jam aren’t they? Because if they admit that they’re offended then they will be proving my very point; that Indians are not sufficiently self critical, and that their views are unbalanced. Muhahaha
A key part of Indian culture is respect for your elders. It is unfortunate that many Australians do not share this value and as a result some elderly people languish unvisited and uncared for in homes across the country. But in India, you find the other extreme. Respect for elders and for authority has created an extremely hierarchical society in which you must call everyone sir or madam. The younger doctors in the hospital where I work are all literally scared of the consultants. If they want to ask a question they do it with so much apology, that every time they do, I’m reminded of Oliver asking “Please sir, may I have some more?” and the consultant replies “MOORRREEE!?!?!?”.
A similar situation exists between children and their parents, where a child will treat their parent’s instructions like the word of god, without question or argument. That’s not to say that the children are unhappy, most feel that their parents know best so it is wise to do as they say. Keep in mind that most parents here will choose their children’s spouses when they are of marrying age.
So? You ask. If both children and parents are happy with the arrangement then what’s the problem? I’ll tell you. This relationship creates an extremely stagnant (Indians would call it stable) social environment. You would be hard pressed to find a culture less open to change and growth. Children do what their parents tell them, and then they get married to who their parents choose, and then instruct their kids the only way they know how, the way their parents taught them.
When talking about arranged marriage, a balanced person would admit that there are many advantages. Some would say that they are more stable and thus, are better for the children. I was part of an interesting conversation yesterday with a girl whose marriage had recently been decided, and her parents. Not long into the conversation however, it became more of a lecture about the faults of western morals and ideals in relation to family values and the far more superior Indian ideals. The high divorce rate was cited as a clear point of evidence, and it was followed by the ridiculous assertion that divorce is just as available to an unhappy Indian spouse as it is to a western spouse. Its disadvantages were glossed over or ignored. Following a tradition blindly and not seeing both its costs and benefits is the very archaic mindset that this country will have to overcome if it wants to improve the standard of living of its people.
Some other unwelcome criticisms that I have are regarding the treatment of women. Tradition and what I consider the extremist social conservative views of many Indians are again to blame. My hospital does a fantastic job of empowering women, but even within it I see sexism. I get my lunch and dinner provided and delivered every day for a minimal fee. Most single people here do the same. When I ask the male married doctors however they say, “Why would I get my meals delivered? I’m married”. It is implied that their wife will cook for them. Many women will not leave the house on their own because they are genuinely scared about what boys will do to them. When confronted about these issues most brush it off. Some have the gall to suggest that thousands of years of tradition have created this culture and so it must be right. Others have the belief that all of these ills are related to the invasion of outsiders and their exploitative ways. Capitalism. OWN YOUR MISTAKES.
India has done so many things in its past to be proud of, but until its people adopt a more balanced view India’s rise will always remain firmly in its future.
Tuesday, November 24, 2009
community
Every night at 5pm a group of about 25 boys of school age get together at the center where I am based. They play for a while and then do their homework. These boys play together, study together, if they are studying late, sometimes sleep together, sometimes eat together and if history is any guide, will remain friends long after they finish school. Some will go on to college, others to jobs straight out of high school, but almost all of them will complete their schooling, and all of them will avoid the perils of drug and alcohol addiction.
I visited a boy’s family yesterday. On the way there, my volunteer friend and I started walking down a very narrow street. It was paved with bricks an on one side was a sewer drain that carried out all the waste from each house. Each house shared at least two of its walls with another and was connected to the street by a small bridge over the sewer. Although there were no street lamps the houses all had electricity and the light from each house was bright enough to make it seem like morning. As we were walking and talking two boys who were playing on the corner started following us. Seeing them, another few boys started to follow, and then another few. My friend put his arm around one of them and whispered something in his ear. The boy then turned around and spread this little bit of juicy gossip, obviously about me, to the rest of the boys who then went from looking and following with mild curiosity to looking with wide eyes and amazement. They were too shy to talk to me straight away but in their whispering amongst themselves I swear the only thing I could understand was “Ricky Ponting…. Ricky Ponting … Ricky Ponting” repeated several times.
When we reached the house we wanted to visit, my friend and I stopped and our entourage stopped behind us. They looked disappointed. It was an anti climax. A large group of marching boys need to be marching for a purpose; a protest or a parade maybe. Their original purpose was gone, but I think there’s something innate within us that loves a good march, so they kept going, about twenty of them, now with a new leader, heading nowhere in particular, but loving the journey anyway.
My friend knew our hosts very well, in fact he also new just about every kid that we came across by name and also their family. Our hosts were the boy, his father, his sister and her friend. The boy, lets call him Ralph, also had another sister and a mother, and all five of them slept and lived and cooked and ate in a house that was about 4m X 4m. I told them that although in my country we all have much bigger houses and cars and T.V.’s I literally don’t know the names of all my neighbors, and unless we need to build a new fence or cut down a tree, we never talk. I told them that I envied the kind of community that they had, and that they were actually rich, because they had all these things that no amount of money could buy.
I visited a boy’s family yesterday. On the way there, my volunteer friend and I started walking down a very narrow street. It was paved with bricks an on one side was a sewer drain that carried out all the waste from each house. Each house shared at least two of its walls with another and was connected to the street by a small bridge over the sewer. Although there were no street lamps the houses all had electricity and the light from each house was bright enough to make it seem like morning. As we were walking and talking two boys who were playing on the corner started following us. Seeing them, another few boys started to follow, and then another few. My friend put his arm around one of them and whispered something in his ear. The boy then turned around and spread this little bit of juicy gossip, obviously about me, to the rest of the boys who then went from looking and following with mild curiosity to looking with wide eyes and amazement. They were too shy to talk to me straight away but in their whispering amongst themselves I swear the only thing I could understand was “Ricky Ponting…. Ricky Ponting … Ricky Ponting” repeated several times.
When we reached the house we wanted to visit, my friend and I stopped and our entourage stopped behind us. They looked disappointed. It was an anti climax. A large group of marching boys need to be marching for a purpose; a protest or a parade maybe. Their original purpose was gone, but I think there’s something innate within us that loves a good march, so they kept going, about twenty of them, now with a new leader, heading nowhere in particular, but loving the journey anyway.
My friend knew our hosts very well, in fact he also new just about every kid that we came across by name and also their family. Our hosts were the boy, his father, his sister and her friend. The boy, lets call him Ralph, also had another sister and a mother, and all five of them slept and lived and cooked and ate in a house that was about 4m X 4m. I told them that although in my country we all have much bigger houses and cars and T.V.’s I literally don’t know the names of all my neighbors, and unless we need to build a new fence or cut down a tree, we never talk. I told them that I envied the kind of community that they had, and that they were actually rich, because they had all these things that no amount of money could buy.
Wednesday, November 18, 2009
Volunteers
Sanjaynagar Mukhundwadi is the name of the slum area where I’m currently posted. The hospital runs a clinic every night from five to eight in which patients can see a doctor and receive medicines for 5 rupees per visit, which is the equivalent of about 17 Australian cents. There are two doctors who sit either side of a small desk in a room that teams with mosquitoes after the sun sets. Together the doctors see up to 180 patients on a very busy day making an average of 2 minutes per consultation. The time is without a doubt insufficient but given the time constraints and lack of manpower, these doctors do an exceptional job of providing healthcare to a community who would otherwise have had to go without. Keep in mind that simple chest infections, skin wounds or dietary deficiencies would have literally destroyed lives and families were it not for these doctors.
That being said, the doctors are only a part, and not even necessarily the most important part of the centre. The doctors come from outside. They were born, raised, educated and now live outside the community. Everyone else who works there are volunteers who were born, raised and now live in the community. I could write endlessly about the centre itself, but this article is primarily about them.
Over the last two days I’ve met many of these volunteers; there are about 20. Most of them are around my age (some of them do not know for sure so they just guess). I got a chance to talk to one of them in depth. I was interested in what motivated this young man, who came from a cash strapped family, to forgo salary paying work and instead work for free for the centre. He told me that when he was growing up he was helped by volunteers from the centre. Young men and women gave him a hand and pulled him up out of the vicious cycle of slum life and now he felt that it was his turn to do the same.
I asked him, what he thought his life would have been like if he had not been pulled out.
He told me that staying in school and continuing his education was the most important difference that was made. You see many children, if not most children, come from families in which their parents are self employed. They are working selling fruits and vegetables, or shining shoes, or working as servants, cooking or cleaning, in the homes of the middle class. Basically in unskilled industries. Most parents want their children to stay in school, but sometimes their insistence is not strong enough, or they do not fully realize its benefits. The children who drop out realize that they too can work in these industries and make some quick cash.
Imagine being in their situation.
It starts off with you ditching school to go and help your dad shine shoes. Like any young kid that idolizes their dad, you feel proud to be doing the same job as him, to be at his level. Soon you realize that instead of working side by side, you can both make more money if you work separately. You’re now earning an income that brings home some desperately needed cash to your family. Your parents are thankful, and again you feel proud. Then you realize that as you get more efficient, if you lie about your income to your parents you can keep some cash for yourself. Cash that’s all yours and nobody elses. Cash that you can do whatever the hell you want with. Why not? After all, you earned it right?
You go watch a movie, you see all the movie stars that everyone always talks about for the first time. You buy your first cigarette, drink your first whisky, why not? All the other men are doing it. Don’t you want to be a man too?
The volunteer I spoke to told me that he can count the number of people in his grade at school that do not drink or smoke on his hands. There are five thousand school going children at any one time in the area.
He doesn’t drink or smoke, and now that he is 22 he no longer feels pressured either, his time is over. He has been saved.
That being said, the doctors are only a part, and not even necessarily the most important part of the centre. The doctors come from outside. They were born, raised, educated and now live outside the community. Everyone else who works there are volunteers who were born, raised and now live in the community. I could write endlessly about the centre itself, but this article is primarily about them.
Over the last two days I’ve met many of these volunteers; there are about 20. Most of them are around my age (some of them do not know for sure so they just guess). I got a chance to talk to one of them in depth. I was interested in what motivated this young man, who came from a cash strapped family, to forgo salary paying work and instead work for free for the centre. He told me that when he was growing up he was helped by volunteers from the centre. Young men and women gave him a hand and pulled him up out of the vicious cycle of slum life and now he felt that it was his turn to do the same.
I asked him, what he thought his life would have been like if he had not been pulled out.
He told me that staying in school and continuing his education was the most important difference that was made. You see many children, if not most children, come from families in which their parents are self employed. They are working selling fruits and vegetables, or shining shoes, or working as servants, cooking or cleaning, in the homes of the middle class. Basically in unskilled industries. Most parents want their children to stay in school, but sometimes their insistence is not strong enough, or they do not fully realize its benefits. The children who drop out realize that they too can work in these industries and make some quick cash.
Imagine being in their situation.
It starts off with you ditching school to go and help your dad shine shoes. Like any young kid that idolizes their dad, you feel proud to be doing the same job as him, to be at his level. Soon you realize that instead of working side by side, you can both make more money if you work separately. You’re now earning an income that brings home some desperately needed cash to your family. Your parents are thankful, and again you feel proud. Then you realize that as you get more efficient, if you lie about your income to your parents you can keep some cash for yourself. Cash that’s all yours and nobody elses. Cash that you can do whatever the hell you want with. Why not? After all, you earned it right?
You go watch a movie, you see all the movie stars that everyone always talks about for the first time. You buy your first cigarette, drink your first whisky, why not? All the other men are doing it. Don’t you want to be a man too?
The volunteer I spoke to told me that he can count the number of people in his grade at school that do not drink or smoke on his hands. There are five thousand school going children at any one time in the area.
He doesn’t drink or smoke, and now that he is 22 he no longer feels pressured either, his time is over. He has been saved.
Monday, November 16, 2009
Homesick
Today I was confronted with the trifecta. Squat toilet. Diarrhea. No toilet paper. Any western person’s nightmare. Needless to say I felt more homesick at that moment than at any other time. Ever.
Hinduism
I was recently involved in two conversations with two very different people about religion. They both claimed that they knew the authentic Hinduism.
The first was a man in the café where I eat breakfast every morning. He proved to me that, irrationality, extremism, ultra-nationalism and xenophobia exist everywhere. It is not only confined to Rush Limbaugh, Allan Jones and Fox news, but exists even in the outskirts of small town India. He told me that Hindus are the Indigenous peoples of India and that Muslims, Christians, Jews etc only exist because they forcibly converted millions of Hindus after invading the country. He told me that I should be scared of Muslims and Christians in Australia because one day they would force me to convert at gunpoint. He felt that all those who left India had betrayed the country and that he would rather die in the emergency room than be treated by a non Indian doctor. As you would expect from me I entertained his psychosis for far too long and sat and argued with him late into the night.
When so many rational, compassionate, and decent Hindus exist, there is obviously no way that he or his views could represent the true Hinduism.
The second conversation was the polar opposite. An intelligent conversation with a respected and admired doctor. He suggested that Hinduism was extremely broad and nowhere did it suggest that you had to believe in a certain god or live in a certain place or undertake certain religious practices. The only thing that his Hinduism required was a set of core values that involved working toward social justice, believing in equality and respecting all peoples. In this reading one can be a Christian or a Muslim and so long as they shared those values they were automatically Hindu whether they knew it or not. This Hinduism is more a philosophy than a religion, and it is one that I feel much more comfortable with.
However, when so many irrational Hindu’s exist why should this represent the true Hinduism? Didn’t they all read the same texts and come from the same tradition?
The name Hindu was given by an external power to a hodgepodge of religious traditions that existed around the Indus river. There is no central power in Hinduism, and as a result I propose that there is no true or pure Hinduism. Each person has their own philosophy and so calling oneself Hindu seems meaningless, so I don’t.
The first was a man in the café where I eat breakfast every morning. He proved to me that, irrationality, extremism, ultra-nationalism and xenophobia exist everywhere. It is not only confined to Rush Limbaugh, Allan Jones and Fox news, but exists even in the outskirts of small town India. He told me that Hindus are the Indigenous peoples of India and that Muslims, Christians, Jews etc only exist because they forcibly converted millions of Hindus after invading the country. He told me that I should be scared of Muslims and Christians in Australia because one day they would force me to convert at gunpoint. He felt that all those who left India had betrayed the country and that he would rather die in the emergency room than be treated by a non Indian doctor. As you would expect from me I entertained his psychosis for far too long and sat and argued with him late into the night.
When so many rational, compassionate, and decent Hindus exist, there is obviously no way that he or his views could represent the true Hinduism.
The second conversation was the polar opposite. An intelligent conversation with a respected and admired doctor. He suggested that Hinduism was extremely broad and nowhere did it suggest that you had to believe in a certain god or live in a certain place or undertake certain religious practices. The only thing that his Hinduism required was a set of core values that involved working toward social justice, believing in equality and respecting all peoples. In this reading one can be a Christian or a Muslim and so long as they shared those values they were automatically Hindu whether they knew it or not. This Hinduism is more a philosophy than a religion, and it is one that I feel much more comfortable with.
However, when so many irrational Hindu’s exist why should this represent the true Hinduism? Didn’t they all read the same texts and come from the same tradition?
The name Hindu was given by an external power to a hodgepodge of religious traditions that existed around the Indus river. There is no central power in Hinduism, and as a result I propose that there is no true or pure Hinduism. Each person has their own philosophy and so calling oneself Hindu seems meaningless, so I don’t.
Imperfections
Every organization has its flaws. They are inevitable, and over the last week I have come to realize one here. I encountered it in a particular patient and then began to notice it everywhere. It is a problem that I, a student of psychology, see far more often than most, but whatever bias I may have it is real, and it costs the patients, this hospital and this country far more that any of us realize.
Last week I took a detailed history of a patient in our general ward. He was experiencing difficulty breathing on even the slightest exertion; and an X-ray showed a partially collapsed lung and several other abnormalities. I understood by talking to him that he had been to several doctors before without much success and had finally come to Hedgewar hospital because of its good reputation. It was suspected that he had a tuberculosis infection, but the existence of other possible illnesses was still in doubt and we needed a CT scan to understand them better.
As soon as the idea was proposed to him he became noticeably frightened. I talked to him briefly later and overheard some of his conversations with others. He had a bad experience some time ago where the electricity had gone out in the middle of the CT scan and he became trapped inside the machine in a pitch dark room. He was worried that something similar was going to happen again and was so scared that he even said ‘let me die, but I’m not going into that machine’ (obviously translated from Marathi). Without the scan we could not just blindly give him treatment so we discharged him.
He was not referred to another doctor and was not given any treatment. Nothing was done to understand the nature of his fear or to try and overcome it. If he dies, he will not die because of his tuberculosis, he will die because of an irrational fear. I do not blame the doctors involved but rather the culture; when I questioned his treatment the response was simple, ‘who has time to treat a psycho (yes, this description was used several times) when there are plenty of other patients waiting?’. This question, though callous may seem rational, but only to someone who is thinking only of the now. The patient has remained ill. He will likely see several other doctors for treatment. He will not get better, he will be readmitted to hospital, his family members will have to take care of him, they will take time off work, and their lives will be greatly impacted. He will cost the hospital, the health system, his family, the economy and the country more now, than if his psychological issues were addressed properly.
Yesterday a man came into the outpatient department with diffuse body pain, trouble sleeping and trouble digesting food. Many tests and investigations had been undertaken over two years and they had all come back normal. My preceptor astutely observed that there was probably a psychosomatic component to his illness so I asked whether I could explore the issue. I sat with the patient and his wife in another room. We started talking about his complaints and then his family, his work and his children. He told me that he had five children and his eldest daughter was married two years ago. Eventually, after a little prodding he told me that his daughter’s husband was severely beating her and that a year ago she ran away from him and returned to live at home.
Although the patient and his wife were absolutely practical about the issue and were in fact encouraging their daughter to run away they admitted that there was definitely a social stigma, and they were feeling the brunt of it. It appears that the wife is thought to bear a greater proportion of the responsibility if a marriage does not work. Furthermore, after she returned home, the husband would call every now and then and threaten her and the family. So as a solution they disconnected their phone.
As treatment my preceptor prescribed some anxiolytics, mostly to help with sleep. But there was really not that much more he could do. He didn’t have the time or the resources to counsel them, and the nature of their problems was only revealed because I had the time to sit with them for 20 minutes. Again, this is in no way my preceptors fault, but it is the fault of a culture that systematically and pathologically pretends that psychological issues do not exist and in my opinion is unknowingly suffering the consequences. If our patient’s somatic symptoms were indeed a manifestation of his anxiety, he will surely be back. If his anxiety is not treated his symptoms will get worse. He may be hospitalized; his family which depends on his income and support will suffer. His kids’ education and future healthcare will be impacted.
Given that the doctors here do indeed care for the community they serve; and given that they approach the clinical and social aspects of medicine with an impressive degree of competence, the psychological aspect of illness needs to improve to the same standard. I’m sure as they come to realize the burden it causes, its importance and emphasis will increase in their practice.
Last week I took a detailed history of a patient in our general ward. He was experiencing difficulty breathing on even the slightest exertion; and an X-ray showed a partially collapsed lung and several other abnormalities. I understood by talking to him that he had been to several doctors before without much success and had finally come to Hedgewar hospital because of its good reputation. It was suspected that he had a tuberculosis infection, but the existence of other possible illnesses was still in doubt and we needed a CT scan to understand them better.
As soon as the idea was proposed to him he became noticeably frightened. I talked to him briefly later and overheard some of his conversations with others. He had a bad experience some time ago where the electricity had gone out in the middle of the CT scan and he became trapped inside the machine in a pitch dark room. He was worried that something similar was going to happen again and was so scared that he even said ‘let me die, but I’m not going into that machine’ (obviously translated from Marathi). Without the scan we could not just blindly give him treatment so we discharged him.
He was not referred to another doctor and was not given any treatment. Nothing was done to understand the nature of his fear or to try and overcome it. If he dies, he will not die because of his tuberculosis, he will die because of an irrational fear. I do not blame the doctors involved but rather the culture; when I questioned his treatment the response was simple, ‘who has time to treat a psycho (yes, this description was used several times) when there are plenty of other patients waiting?’. This question, though callous may seem rational, but only to someone who is thinking only of the now. The patient has remained ill. He will likely see several other doctors for treatment. He will not get better, he will be readmitted to hospital, his family members will have to take care of him, they will take time off work, and their lives will be greatly impacted. He will cost the hospital, the health system, his family, the economy and the country more now, than if his psychological issues were addressed properly.
Yesterday a man came into the outpatient department with diffuse body pain, trouble sleeping and trouble digesting food. Many tests and investigations had been undertaken over two years and they had all come back normal. My preceptor astutely observed that there was probably a psychosomatic component to his illness so I asked whether I could explore the issue. I sat with the patient and his wife in another room. We started talking about his complaints and then his family, his work and his children. He told me that he had five children and his eldest daughter was married two years ago. Eventually, after a little prodding he told me that his daughter’s husband was severely beating her and that a year ago she ran away from him and returned to live at home.
Although the patient and his wife were absolutely practical about the issue and were in fact encouraging their daughter to run away they admitted that there was definitely a social stigma, and they were feeling the brunt of it. It appears that the wife is thought to bear a greater proportion of the responsibility if a marriage does not work. Furthermore, after she returned home, the husband would call every now and then and threaten her and the family. So as a solution they disconnected their phone.
As treatment my preceptor prescribed some anxiolytics, mostly to help with sleep. But there was really not that much more he could do. He didn’t have the time or the resources to counsel them, and the nature of their problems was only revealed because I had the time to sit with them for 20 minutes. Again, this is in no way my preceptors fault, but it is the fault of a culture that systematically and pathologically pretends that psychological issues do not exist and in my opinion is unknowingly suffering the consequences. If our patient’s somatic symptoms were indeed a manifestation of his anxiety, he will surely be back. If his anxiety is not treated his symptoms will get worse. He may be hospitalized; his family which depends on his income and support will suffer. His kids’ education and future healthcare will be impacted.
Given that the doctors here do indeed care for the community they serve; and given that they approach the clinical and social aspects of medicine with an impressive degree of competence, the psychological aspect of illness needs to improve to the same standard. I’m sure as they come to realize the burden it causes, its importance and emphasis will increase in their practice.
Nobility in theory and practice
No one is evil.
Everyone’s default setting is good, but sometimes their goodness gets corrupted by selfishness or stupidity or anger. Having a selfless and noble philosophy is a good start; but then again selfless and noble philosophies are a dime a dozen. Go to any comic book store and you’ll read how batman never compromises his belief in justice for the sake of expediency, most constitutions (but not Australia’s) are enshrined with values such as that we are all born with certain inalienable rights including life, liberty and the pursuit of happiness. But not everybody has the opportunity or the strength of will to put them into practice.
What follows are some examples of nobility in practice that I have come across so far during my time here.
I was sitting in my preceptor’s surgery today when a man who works in the hospitals blood bank came in to talk about a patient. Let’s call him Dave. Dave had a low platelet count and despite several transfusions the count was not rising substantially. Dave was financially strained and would not be able to afford transfusions for much longer. He was from a rural town and was recently forced to sell his house in order to afford treatment. He also had children and the man from the blood bank (Barry) was worried that their education and their future prospects may be being unintentionally sacrificed. Barry suggested that patients often do not reveal these concerns to their doctors unless asked and so was advising my preceptor to tell Dave plainly if he had a problem with hematopoiesis (blood cell, including platelet production). That way, he would not continue spending money on transfusions that were not fixing the underlying problem. What impressed me here was simply that Barry took the time to enquire about Dave’s personal life and then put in the effort to confront Dave’s doctor about the issue. The effort was not much but it revealed that Barry really cared for this stranger, hence, nobility in practice.
Patients come in occasionally without any family members. In India, a patient’s family does a lot of what we Australians would expect the hospital to take care of. A simple example is with drugs. Here, a doctor will prescribe the drugs, but then it is the patient’s responsibility to acquire them from an outside pharmacy and make sure that they are being taken as prescribed. With such a system patients who come in on their own are in a bit of a bind. Patients here do not wear hospital gowns, they just wear the clothes they came in with, and if they want a blanket they have to bring it themselves. We were told toady of such a patient, and before I could think of the blanket situation, my preceptor said that he had a spare blanket at home and that if the patient needed it he could have it. Again, the effort was minimal, but the thought and the offer revealed that my preceptor cared.
In an urban slum, three doctors I met have dedicated themselves to not only look after the health of their respective communities but also to act as mentors and help with social, economic, marital and other problems. Their effort is maximal and reveals thorough nobility in philosophy and practice.
It is comforting to be surrounded by such people, people who have maintained their default setting.
Everyone’s default setting is good, but sometimes their goodness gets corrupted by selfishness or stupidity or anger. Having a selfless and noble philosophy is a good start; but then again selfless and noble philosophies are a dime a dozen. Go to any comic book store and you’ll read how batman never compromises his belief in justice for the sake of expediency, most constitutions (but not Australia’s) are enshrined with values such as that we are all born with certain inalienable rights including life, liberty and the pursuit of happiness. But not everybody has the opportunity or the strength of will to put them into practice.
What follows are some examples of nobility in practice that I have come across so far during my time here.
I was sitting in my preceptor’s surgery today when a man who works in the hospitals blood bank came in to talk about a patient. Let’s call him Dave. Dave had a low platelet count and despite several transfusions the count was not rising substantially. Dave was financially strained and would not be able to afford transfusions for much longer. He was from a rural town and was recently forced to sell his house in order to afford treatment. He also had children and the man from the blood bank (Barry) was worried that their education and their future prospects may be being unintentionally sacrificed. Barry suggested that patients often do not reveal these concerns to their doctors unless asked and so was advising my preceptor to tell Dave plainly if he had a problem with hematopoiesis (blood cell, including platelet production). That way, he would not continue spending money on transfusions that were not fixing the underlying problem. What impressed me here was simply that Barry took the time to enquire about Dave’s personal life and then put in the effort to confront Dave’s doctor about the issue. The effort was not much but it revealed that Barry really cared for this stranger, hence, nobility in practice.
Patients come in occasionally without any family members. In India, a patient’s family does a lot of what we Australians would expect the hospital to take care of. A simple example is with drugs. Here, a doctor will prescribe the drugs, but then it is the patient’s responsibility to acquire them from an outside pharmacy and make sure that they are being taken as prescribed. With such a system patients who come in on their own are in a bit of a bind. Patients here do not wear hospital gowns, they just wear the clothes they came in with, and if they want a blanket they have to bring it themselves. We were told toady of such a patient, and before I could think of the blanket situation, my preceptor said that he had a spare blanket at home and that if the patient needed it he could have it. Again, the effort was minimal, but the thought and the offer revealed that my preceptor cared.
In an urban slum, three doctors I met have dedicated themselves to not only look after the health of their respective communities but also to act as mentors and help with social, economic, marital and other problems. Their effort is maximal and reveals thorough nobility in philosophy and practice.
It is comforting to be surrounded by such people, people who have maintained their default setting.
Monday, November 9, 2009
Work
An 18 year old boy looks after the guest house where I am temporarily staying. He works for 8 hours every day from Monday to Sunday. His parents own a small shop in the market district and after work every day he goes to sit in the shop. He is in his last year of school so while sitting in the shop he studies and after the shop closes he finishes any study that he has to do. I saw him working last Sunday and was surprised, I asked him when he takes time off and he old me that he doesn’t. He told me that days-off breed laziness.
I had that day off and I spent most of it wandering aimlessly.
My preceptor starts work at about 9 30 and works till 2 he then starts again at 5 30 and goes till about 9. He has cut down his work hours because he thinks it is important to spend some time with his family.
The junior doctors that I work with start work at about 8 and do all their pre round work before the consultants like my preceptor arrive at 9 30. They take about an hour for lunch and then stick around to do post round work after the consultants leave at 9 pm. When I asked my friend what he does on his days off he says that he doesn’t take any. He saves them up and then goes home for 4 or five days every couple of months.
I have been working the same hours of them and already after a week am feeling burned out. I come from a country where the average income is around $35 000 a year. Most people in India earn less that $2 per day.
Why?
I had that day off and I spent most of it wandering aimlessly.
My preceptor starts work at about 9 30 and works till 2 he then starts again at 5 30 and goes till about 9. He has cut down his work hours because he thinks it is important to spend some time with his family.
The junior doctors that I work with start work at about 8 and do all their pre round work before the consultants like my preceptor arrive at 9 30. They take about an hour for lunch and then stick around to do post round work after the consultants leave at 9 pm. When I asked my friend what he does on his days off he says that he doesn’t take any. He saves them up and then goes home for 4 or five days every couple of months.
I have been working the same hours of them and already after a week am feeling burned out. I come from a country where the average income is around $35 000 a year. Most people in India earn less that $2 per day.
Why?
The markets
If you want to se capitalism don’t go to Wall street, come to India. For markets to function properly economists make certain assumptions. Some of these are that everyone is rational, everyone is looking out for themselves and themselves alone, that everyone has perfect information about products and prices etc. and fourth that there is perfect competition. These assumptions are always wrong. But economists cant be bothered working out by how much so they just assume that their assumptions are true and then use these assumptions to guide public policy and make predictions. Genius isn’t it.
But yesterday I went to a place where these assumptions are more right that anywhere else I have ever seen. I asked my friend rickshaw driver to take me to Paithan Gate, the most crowded shopping district in Aurangabad, and from there I walked around without any particular purpose.
When I got to the outskirts I came across a shop called “Sham electronic repairs” (Sham is a common Indian name). I thought my non Indian friends would get a kick out of the pun so I took out my camera to take a photo. As soon as I did two cute children ran up to me and asked me to show them the picture I took. They looked at my picture and then looked at the shop and started laughing. I took a picture of the boy and showed it to him and he got all excited, but then his big sister pushed him out of the way and told me to take one of her. I took one of her and she had a similar reaction. These kids had no shoes and were literally wearing rags but they were just as happy as any other kids I’ve seen. That made me happy too.
Nerrala bazaar, means different market in Hindi, and it was the next place I stumbled across. Goats, pigs, people, cows, dogs all cramped into this tiny open space between two meanders of the river. Each product was sold by at least four different people who were all located next to each other. They each had their little spot on the ground with their products, such as fruits or clothes spread neatly on a thin sheet on the dirt. They all shouted prices and if I went to talk to one of them about price it instantly became an auction between the four. If they tried to collude amongst themselves they new that a new person would set up shop tomorrow and undercut them. Thus, there was perfect competition. All the products were there for you to see and touch and the going price was well established by the shouting salesmen, thus there was perfect information.
But the, flaws of capitalism were also clearly on display. Since there was no government interference, there were no regulations on child labor and children who seemed just old enough to talk were carrying things for their parents or putting things in bags for me. Also, publicly owned resources like the air and the environment were being grossly exploited. The stench of smoke and dust and feces was more than noticeable and the river was worse than a sewer, flowing with trash and oil, with pigs wallowing in the mud and people urinating and defecating on nearby rocks.
Nevertheless, this market feeds thousands provides a steady income for thousands more, although the environment suffers it keeps kids in school and parents in work, we just have to figure out a way to stop if from being one or the other.
But yesterday I went to a place where these assumptions are more right that anywhere else I have ever seen. I asked my friend rickshaw driver to take me to Paithan Gate, the most crowded shopping district in Aurangabad, and from there I walked around without any particular purpose.
When I got to the outskirts I came across a shop called “Sham electronic repairs” (Sham is a common Indian name). I thought my non Indian friends would get a kick out of the pun so I took out my camera to take a photo. As soon as I did two cute children ran up to me and asked me to show them the picture I took. They looked at my picture and then looked at the shop and started laughing. I took a picture of the boy and showed it to him and he got all excited, but then his big sister pushed him out of the way and told me to take one of her. I took one of her and she had a similar reaction. These kids had no shoes and were literally wearing rags but they were just as happy as any other kids I’ve seen. That made me happy too.
Nerrala bazaar, means different market in Hindi, and it was the next place I stumbled across. Goats, pigs, people, cows, dogs all cramped into this tiny open space between two meanders of the river. Each product was sold by at least four different people who were all located next to each other. They each had their little spot on the ground with their products, such as fruits or clothes spread neatly on a thin sheet on the dirt. They all shouted prices and if I went to talk to one of them about price it instantly became an auction between the four. If they tried to collude amongst themselves they new that a new person would set up shop tomorrow and undercut them. Thus, there was perfect competition. All the products were there for you to see and touch and the going price was well established by the shouting salesmen, thus there was perfect information.
But the, flaws of capitalism were also clearly on display. Since there was no government interference, there were no regulations on child labor and children who seemed just old enough to talk were carrying things for their parents or putting things in bags for me. Also, publicly owned resources like the air and the environment were being grossly exploited. The stench of smoke and dust and feces was more than noticeable and the river was worse than a sewer, flowing with trash and oil, with pigs wallowing in the mud and people urinating and defecating on nearby rocks.
Nevertheless, this market feeds thousands provides a steady income for thousands more, although the environment suffers it keeps kids in school and parents in work, we just have to figure out a way to stop if from being one or the other.
Saturday, November 7, 2009
Bibi ka Muqbara
It was sad to see the slowly crumbling vestiges of a once powerful opulent empire. An empire that had the extra cash to build two almost identical, massive structures on opposite sides of the country. Bibi ka maqbara was built by the son of Aurangzeb, who was the founder of Aurangabad and the son of Shah Jahan, the emperor who built the Taj Mahal. It was meant to rival the Taj, but sadly the architectural fashion of the day resulted in it being less ornate, and therefore, less appreciated in the centuries that followed. It is, without doubt a beautiful and impressive structure but sadly it is always compared to the Taj. And it always falls short and thus has always been neglected.
I strolled around the mausoleum and imagined how it would have looked when it was built, with its shiny marble designs, its ungratified walls, it’s well kept gardens and its pools filled with water. I shouldn’t be too hard on them though, it’s still commendable that a 300 year old building has been kept largely in tact. But they could have done better.
Perhaps my view was tainted because I had just lost my phone.
I was talking on it when I got into the rickshaw and when I got out it was gone, but finding out where that rickshaw driver went and how I could find him again seemed hopeless. I had a robust session of haggling with him before I got in as well so perhaps this was some kind of payback. All my numbers were in there. And worse yet I was imagining the lecture I was going to get from my parents when I told them, especially given how I had lost my phone the last time I was in India.
Without my phone I felt naked. Unable to call anyone if anything happened to me. Removed from the world. I cant remember the last time I was phoneless. It’s a strange feeling, liberating, scary and lonely all at the same time. Iv decided im going to try it for a week when I get back to Brisbane just to see how it goes.
So there I was, the sun setting, phoneless, helpless and annoyed. I took a seat directly in front of the building in between two big clay pots. It was the best seat in the house and as the sun set and shone red and yellow onto the white monument all its imperfections disappeared. I sat for about and hour and watched all the colours, first the brown of smog, then yellow, orange, red and black and finally was appreciate it as Aurangzeb intended.
So about my phone, after another haggling session to get a rickshaw back I went to the stand where I caught the original ric. Long story short, I was super lucky, the driver had found it and I eventually got it back. I paid him a bakshish (prize) of 500 rupees but realized soon after that maybe I was swindled. Did the driver take my phone in the scuffle at the very beginning with the sole intention of getting a bakshish?
Can I hold such a dim view of humanity to think that this is actually possible? I decided to err on the side of trust. It’s better to believe that everyone is honest and be disappointed occasionally than believe that everyone is dishonest. The driver, Shriram is now my driver of choice, I have his phone number, and whenever I want to go anywhere he is the one I call. It’s worked out twice so far and it seems that believing in his integrity was the right decision. Honesty 1, dishonesty 0.
I strolled around the mausoleum and imagined how it would have looked when it was built, with its shiny marble designs, its ungratified walls, it’s well kept gardens and its pools filled with water. I shouldn’t be too hard on them though, it’s still commendable that a 300 year old building has been kept largely in tact. But they could have done better.
Perhaps my view was tainted because I had just lost my phone.
I was talking on it when I got into the rickshaw and when I got out it was gone, but finding out where that rickshaw driver went and how I could find him again seemed hopeless. I had a robust session of haggling with him before I got in as well so perhaps this was some kind of payback. All my numbers were in there. And worse yet I was imagining the lecture I was going to get from my parents when I told them, especially given how I had lost my phone the last time I was in India.
Without my phone I felt naked. Unable to call anyone if anything happened to me. Removed from the world. I cant remember the last time I was phoneless. It’s a strange feeling, liberating, scary and lonely all at the same time. Iv decided im going to try it for a week when I get back to Brisbane just to see how it goes.
So there I was, the sun setting, phoneless, helpless and annoyed. I took a seat directly in front of the building in between two big clay pots. It was the best seat in the house and as the sun set and shone red and yellow onto the white monument all its imperfections disappeared. I sat for about and hour and watched all the colours, first the brown of smog, then yellow, orange, red and black and finally was appreciate it as Aurangzeb intended.
So about my phone, after another haggling session to get a rickshaw back I went to the stand where I caught the original ric. Long story short, I was super lucky, the driver had found it and I eventually got it back. I paid him a bakshish (prize) of 500 rupees but realized soon after that maybe I was swindled. Did the driver take my phone in the scuffle at the very beginning with the sole intention of getting a bakshish?
Can I hold such a dim view of humanity to think that this is actually possible? I decided to err on the side of trust. It’s better to believe that everyone is honest and be disappointed occasionally than believe that everyone is dishonest. The driver, Shriram is now my driver of choice, I have his phone number, and whenever I want to go anywhere he is the one I call. It’s worked out twice so far and it seems that believing in his integrity was the right decision. Honesty 1, dishonesty 0.
Thursday, November 5, 2009
unhelpable patients
There are serious downsides to being seen as gods.
As Uncle Ben said, with great power comes great responsibility, and from the patient histories I have taken, these responsibilities are often not taken seriously. Many patients in the general ward have complained that their rural doctors are not up to the mark; one was a very similar case to one I described previously in the out patient department, where a patient with a chronic lung condition was prescribed an oral drug when an inhaler was more effective. Just as insidious as incompetence, however, is laziness and corruption. Patients and doctors alike have complained that there is a chronic poor work ethic in public hospitals. An example I was given was that ultrasound machines would just lie unused for months because a small bulb had stopped working and no one had bothered to order a new one because the red tape was too cumbersome. These impressions have come from second hand sources and are probably biased so I shouldn’t be too quick to judge.
The other responsibility that I experienced first hand was the greater extent that patients involve you in their lives. Patients are much more likely to reveal social and economic problems if they respect you. As I took histories yesterday in an urban slum I would begin asking about their chest pain or their tiredness but as soon as I would ask about their home life, or other things that were causing them tension they would immediately give me the grand tour of their lives. I had women telling me about their money problems, asking me what they will do if they cannot afford treatment, a man told me about their daughter’s children and how they were willing to forgo healthcare in order to pay school fees.
A case that really affected me though, was an old woman who came in with her neighbor into my preceptor’s surgery. This woman lives about 100 kilometers away which means that it costs around 200 rupees for the two way journey. The woman complained of chest pain, had a high blood pressure and uncontrolled type 2 diabetes. She was about 60 and lived on a farm with her only son and his family. She had two daughters, but as is the custom here the daughters live with their husbands families and have very little to do with their biological parents after marriage.
She began to tell the doctor about her tiredness when she broke down crying. She told us that her son now owned the family farm and had told her that since she was no longer capable of working, she was no longer any use to him. Rather that saving any money for oneself it is the custom here that ones children will look after you in your twilight years. If they do not, well, nothing….
It was so painful for me to see this woman so utterly broken. A broken body, a broken spirit, she was worthless to her son and because of that she believed she was worthless herself. It is a fear for all of us, sometimes conscious sometimes not, that at the end of our lives we will look back and be disappointed. We are by far our own harshest critics, and self disappointment hurts more than any other. I felt great sympathy for this woman who I knew was looking back on a life that she felt was wasted; that added nothing. My preceptor and I discussed her case over tea the next day and even if she doesn’t know it, I can be sure that that woman added something new to my perspective…..
So what can we do for her? Unfortunately not much, we can reduce the prices of her medicine, we can give her a larger stock of medicines that will last longer so that she doesn’t have to make the journey into town as often. But as for her psyche, we can empathize, tell her that we will take care of her health, and show her some of the compassion that her jackass son robbed her of; but we do not have the time or the ability to do family therapy or otherwise improve her social situation. More urgent matters occupy our time, our time is already stretched to the limit and well that’s it……. I’m out of time….
As Uncle Ben said, with great power comes great responsibility, and from the patient histories I have taken, these responsibilities are often not taken seriously. Many patients in the general ward have complained that their rural doctors are not up to the mark; one was a very similar case to one I described previously in the out patient department, where a patient with a chronic lung condition was prescribed an oral drug when an inhaler was more effective. Just as insidious as incompetence, however, is laziness and corruption. Patients and doctors alike have complained that there is a chronic poor work ethic in public hospitals. An example I was given was that ultrasound machines would just lie unused for months because a small bulb had stopped working and no one had bothered to order a new one because the red tape was too cumbersome. These impressions have come from second hand sources and are probably biased so I shouldn’t be too quick to judge.
The other responsibility that I experienced first hand was the greater extent that patients involve you in their lives. Patients are much more likely to reveal social and economic problems if they respect you. As I took histories yesterday in an urban slum I would begin asking about their chest pain or their tiredness but as soon as I would ask about their home life, or other things that were causing them tension they would immediately give me the grand tour of their lives. I had women telling me about their money problems, asking me what they will do if they cannot afford treatment, a man told me about their daughter’s children and how they were willing to forgo healthcare in order to pay school fees.
A case that really affected me though, was an old woman who came in with her neighbor into my preceptor’s surgery. This woman lives about 100 kilometers away which means that it costs around 200 rupees for the two way journey. The woman complained of chest pain, had a high blood pressure and uncontrolled type 2 diabetes. She was about 60 and lived on a farm with her only son and his family. She had two daughters, but as is the custom here the daughters live with their husbands families and have very little to do with their biological parents after marriage.
She began to tell the doctor about her tiredness when she broke down crying. She told us that her son now owned the family farm and had told her that since she was no longer capable of working, she was no longer any use to him. Rather that saving any money for oneself it is the custom here that ones children will look after you in your twilight years. If they do not, well, nothing….
It was so painful for me to see this woman so utterly broken. A broken body, a broken spirit, she was worthless to her son and because of that she believed she was worthless herself. It is a fear for all of us, sometimes conscious sometimes not, that at the end of our lives we will look back and be disappointed. We are by far our own harshest critics, and self disappointment hurts more than any other. I felt great sympathy for this woman who I knew was looking back on a life that she felt was wasted; that added nothing. My preceptor and I discussed her case over tea the next day and even if she doesn’t know it, I can be sure that that woman added something new to my perspective…..
So what can we do for her? Unfortunately not much, we can reduce the prices of her medicine, we can give her a larger stock of medicines that will last longer so that she doesn’t have to make the journey into town as often. But as for her psyche, we can empathize, tell her that we will take care of her health, and show her some of the compassion that her jackass son robbed her of; but we do not have the time or the ability to do family therapy or otherwise improve her social situation. More urgent matters occupy our time, our time is already stretched to the limit and well that’s it……. I’m out of time….
Doctors are still gods in India
My hospital has used that to its advantage and placed several doctors in rural and slum areas to not only look after health but also act as mentors and community leaders. Healthcare is not holistic because our wanky biopsychosocial curriculum tells us it is. It’s holistic because people are not defined by their illnesses.
An illness is part of who someone is when they have it. But whether they contract it and how it progresses is not only determined by the nature of the illness but also the nature of the person. People are shaped by their genes and their environment. Therefore to uplift communities and improve their resilience we must focus on improving their environment. Hedgewar hospital espouses this philosophy and not only treats the ill but also runs schools, adult education programmes, micro credit schemes and preventative health workshops to uplift communities.
Gandhi said ‘Be the change you want to see in the world’. The doctors at this hospital are doing just that.
I read something else in the lunch room at the hospital that I thought would fit well here. It goes something like this.
“When I was a young man I wanted to change the world, but that was too difficult so I tried to change my nation. When I found I couldn’t change my nation I tried to change my town. But I couldn’t change my town either so as an older man I tried to change my family. Now as an old man I have come to a realization. If as a young man I had changed myself I would have changed my family. Me and my family could have had an impact on our town, and my town could have changed my nation and indeed the world.”
An illness is part of who someone is when they have it. But whether they contract it and how it progresses is not only determined by the nature of the illness but also the nature of the person. People are shaped by their genes and their environment. Therefore to uplift communities and improve their resilience we must focus on improving their environment. Hedgewar hospital espouses this philosophy and not only treats the ill but also runs schools, adult education programmes, micro credit schemes and preventative health workshops to uplift communities.
Gandhi said ‘Be the change you want to see in the world’. The doctors at this hospital are doing just that.
I read something else in the lunch room at the hospital that I thought would fit well here. It goes something like this.
“When I was a young man I wanted to change the world, but that was too difficult so I tried to change my nation. When I found I couldn’t change my nation I tried to change my town. But I couldn’t change my town either so as an older man I tried to change my family. Now as an old man I have come to a realization. If as a young man I had changed myself I would have changed my family. Me and my family could have had an impact on our town, and my town could have changed my nation and indeed the world.”
Fear
Sadness, loss, concern, desperation, determination, loss of hope, perseverance, courage and anger are all emotions I had prepared myself to see. But one emotion caught me by surprise. Fear. It seems so obvious to me now, but my lack of mental preparedness meant that I was caught completely off guard when I saw the face of one of the patients in our ward a few days ago. He suffers from a chronic lung disease and despite gasping for breath, oxygen was not sufficiently reaching his blood. He was straining every wasted muscle he had left, and sitting atop his fragile broken body was a face that knew that something horrible was happening. Wide eyes, fast heavy breathing, pale wrinkled face, sweating bullets clutching his sons hand with his left and his doctors with his right. His high pitched voice, speaking what he thought were his dying words, were barely audible but the message was loud and clear. “I am scared. Do something. Anything”. He survived.
Fear is something that I’ve been noticing more and more since that first encounter. A child was undergoing her first operation without general anesthetic. Putting myself in her shoes I imagined lying on a metal table in a cold room surrounded by faceless strangers covered in blue or green. Their surgical masks revealing only their beady eyes void of sympathy or emotion that knew me by number alone. Even if I yelled for my parents they wouldn’t hear me, and anyway fear had reduced my voice to a whisper.
Fear is something that I’ve been noticing more and more since that first encounter. A child was undergoing her first operation without general anesthetic. Putting myself in her shoes I imagined lying on a metal table in a cold room surrounded by faceless strangers covered in blue or green. Their surgical masks revealing only their beady eyes void of sympathy or emotion that knew me by number alone. Even if I yelled for my parents they wouldn’t hear me, and anyway fear had reduced my voice to a whisper.
Friday, October 30, 2009
OPD
Out patient department
I got a tour of the hospital today and had breakfast and lunch with the staff. I noticed a few more cultural quirks that I should cronicle. Firstly, Indians are immune to the awkward silence. They will only speak when there is something to say and there is no fluff, which means that if you are having lunch or just sitting with people you know, you can sit for minutes without anyone saying a word. And people dont feel the need to fidget or twiddle their thumbs either. They just sit and stare. Not that the conversation isnt lively and interesting when it happens but there is less inane bable about subjects such as the weather and everybody's health. I originally thought it was me, but then i noticed other groups of people doing it too. Secondly, there is a strict heirarchy, everyone above you is sir or madam. I made the mistake of referring to a doctor by only his last name without adding sir, and even though i wasnt in his presence a freind of mine corrected me and told me how important it was to stick to this etiquette. Its particularly difficult when you come from a land where I have known all my teachers for the past six years on a first name basis.
So anyway, today I hung out at the outpatient department under the auspices of my preceptor, an incredibly efficient man. Whilst working he seems to have each second so carefuly planned out and rehersed that doctoring is simply a polished performance. With around 20 patients literally standing outside his door at any one time, the ammount of time that he could spend with each one was two minutes at a maximum. All the history taking techniques are completely useless when you are constrained by such pressures. Yet he stil managed to establish rapore, crack a joke everunow and then and give the imression that he cared. Issues of compliance. Sorry. Concordance, were in my mind constantly, but its not feasable to do anything about it. Luckily there allways seems to be an assistant doctor to write everything down for the patient which is no doubt helpfull. But then many patients can't read. Privacy is also a complete non issue, with both the previous patient and the next patient often in the room while the current patient's consultation is in progress. Plus often the whole family will be there. The amount of time we spent considering the legal implications of prescribing the OCP to minors is so thouroughly irrelevent here.
I felt throughout my entire day there that this is where real medicine is practised. All the presenting cases were so varied and each patient had waited so long to see the doctor that we could be sure that whatever their complaint was it was causing a major problem.
Theres so much more I can say and that I learnt, like I didnt know you can get cushings by taking oral corticosteroids for the purpose of bronchodialation. Patients don't realize that an inhaler can do the job better, but they are either too expensive or the patients preffer the tablets because tablets feel more like medicine.
I had dinner today for about 35 cents australian. I now get what they call here a 'tiffin' which is basically a bunch of different vegetable curries, bread and rice. One for lunch and one for dinner, allways different amazing curries for 30 rupees a day. or 1000 rupees a month. Thats about 25 dollars a month which is about 80 cents a day. And I can barely finish the portions. 9 dollar noodle house noodles. pfft, i might as well throw my money down the toilet.
I got a tour of the hospital today and had breakfast and lunch with the staff. I noticed a few more cultural quirks that I should cronicle. Firstly, Indians are immune to the awkward silence. They will only speak when there is something to say and there is no fluff, which means that if you are having lunch or just sitting with people you know, you can sit for minutes without anyone saying a word. And people dont feel the need to fidget or twiddle their thumbs either. They just sit and stare. Not that the conversation isnt lively and interesting when it happens but there is less inane bable about subjects such as the weather and everybody's health. I originally thought it was me, but then i noticed other groups of people doing it too. Secondly, there is a strict heirarchy, everyone above you is sir or madam. I made the mistake of referring to a doctor by only his last name without adding sir, and even though i wasnt in his presence a freind of mine corrected me and told me how important it was to stick to this etiquette. Its particularly difficult when you come from a land where I have known all my teachers for the past six years on a first name basis.
So anyway, today I hung out at the outpatient department under the auspices of my preceptor, an incredibly efficient man. Whilst working he seems to have each second so carefuly planned out and rehersed that doctoring is simply a polished performance. With around 20 patients literally standing outside his door at any one time, the ammount of time that he could spend with each one was two minutes at a maximum. All the history taking techniques are completely useless when you are constrained by such pressures. Yet he stil managed to establish rapore, crack a joke everunow and then and give the imression that he cared. Issues of compliance. Sorry. Concordance, were in my mind constantly, but its not feasable to do anything about it. Luckily there allways seems to be an assistant doctor to write everything down for the patient which is no doubt helpfull. But then many patients can't read. Privacy is also a complete non issue, with both the previous patient and the next patient often in the room while the current patient's consultation is in progress. Plus often the whole family will be there. The amount of time we spent considering the legal implications of prescribing the OCP to minors is so thouroughly irrelevent here.
I felt throughout my entire day there that this is where real medicine is practised. All the presenting cases were so varied and each patient had waited so long to see the doctor that we could be sure that whatever their complaint was it was causing a major problem.
Theres so much more I can say and that I learnt, like I didnt know you can get cushings by taking oral corticosteroids for the purpose of bronchodialation. Patients don't realize that an inhaler can do the job better, but they are either too expensive or the patients preffer the tablets because tablets feel more like medicine.
I had dinner today for about 35 cents australian. I now get what they call here a 'tiffin' which is basically a bunch of different vegetable curries, bread and rice. One for lunch and one for dinner, allways different amazing curries for 30 rupees a day. or 1000 rupees a month. Thats about 25 dollars a month which is about 80 cents a day. And I can barely finish the portions. 9 dollar noodle house noodles. pfft, i might as well throw my money down the toilet.
Thursday, October 29, 2009
Aurangabad
So i got out of the bus depot with all my bags and as expected four or five men were vying for my attention and to be my rickshaw driver. One of them reached over and motioned to grab my bag. I gave him a stern look. He backed away.
Hahaha. I was laughing on the inside when I gave the look as well. That driver new that he was out of my favour so he backed off and left it to the others. I really wanted to reach over to him and say, tough luck mate, thanks for playing. Getting around in India seems to be filled with little games like this. And iv realized that it makes almost no difference whether you win or lose. If a shopkeeper or taxi driver manages to squeeze a few extra rupees out of me i am usually too impressed by their skill to really care about the money. Although in constant competition, there is a strong sense of respect between any two negotiators so long as they are not incompetent enough to get trampled on.
So one of the drivers made a quote of 55 and I waited, no one made a counter offer so i took it. But then some guy flashed a card in my face and said he was part of some government branch that wanted to see what was in my bags. I laughed and brushed him away thinking that he was trying to steal my stuff. Then he said he couldnt let me leave untill I did and spoke a whole bunch of very fast Hindi, which I don't understand. I asked him to expain it in Marathi but he was too fast again. I was considering offering him a bribe to shut up and let me go, but eventually i understood that he was something like a customs official searching to make sure that i wasn't importing goods into the city to sell. So i complied and everything ended rolsyly, but im very tempted to start a rant on the flawed ecconomics of taxing people who are importing goods. Ill leave that for my personal diary though haha, because knowing me its gonna be super long.
Hedgewar hospital is incredible. Its only 150 beds but the number of outpatient work that they do makes it a lot bigger. One of the Hospital directors (Dr. Pandhare) was telling me that they stop taking new arrivals at about 12 and it takes till about 3 30 to see everyone that has registered by then. There are several models under which hospitals operate in India, there are large profit making private hospitals that offer the best quality care that only the wealthiest can afford. There are large public hospitals that are free and thus cater for the poorest of the poor, but are wracked with corruption and crippled with beurocracy, there are small private clinics set up by individual doctors that can often run very successfully but are limmited in ther capabillities and there is a fourth model. Hedgewar is this fourth model, where a philosophy of dedication to service guides the staff. It was established by seven doctors about 20 years ago who decided to forgo most material benefits of medical practise and focus on service. An unusual fit within a capitalist ecconomy, but it worked. There are 514 staff now and they service an area that is 250km in diameter.
I shouldnt get too excited though but im super excited.
Hahaha. I was laughing on the inside when I gave the look as well. That driver new that he was out of my favour so he backed off and left it to the others. I really wanted to reach over to him and say, tough luck mate, thanks for playing. Getting around in India seems to be filled with little games like this. And iv realized that it makes almost no difference whether you win or lose. If a shopkeeper or taxi driver manages to squeeze a few extra rupees out of me i am usually too impressed by their skill to really care about the money. Although in constant competition, there is a strong sense of respect between any two negotiators so long as they are not incompetent enough to get trampled on.
So one of the drivers made a quote of 55 and I waited, no one made a counter offer so i took it. But then some guy flashed a card in my face and said he was part of some government branch that wanted to see what was in my bags. I laughed and brushed him away thinking that he was trying to steal my stuff. Then he said he couldnt let me leave untill I did and spoke a whole bunch of very fast Hindi, which I don't understand. I asked him to expain it in Marathi but he was too fast again. I was considering offering him a bribe to shut up and let me go, but eventually i understood that he was something like a customs official searching to make sure that i wasn't importing goods into the city to sell. So i complied and everything ended rolsyly, but im very tempted to start a rant on the flawed ecconomics of taxing people who are importing goods. Ill leave that for my personal diary though haha, because knowing me its gonna be super long.
Hedgewar hospital is incredible. Its only 150 beds but the number of outpatient work that they do makes it a lot bigger. One of the Hospital directors (Dr. Pandhare) was telling me that they stop taking new arrivals at about 12 and it takes till about 3 30 to see everyone that has registered by then. There are several models under which hospitals operate in India, there are large profit making private hospitals that offer the best quality care that only the wealthiest can afford. There are large public hospitals that are free and thus cater for the poorest of the poor, but are wracked with corruption and crippled with beurocracy, there are small private clinics set up by individual doctors that can often run very successfully but are limmited in ther capabillities and there is a fourth model. Hedgewar is this fourth model, where a philosophy of dedication to service guides the staff. It was established by seven doctors about 20 years ago who decided to forgo most material benefits of medical practise and focus on service. An unusual fit within a capitalist ecconomy, but it worked. There are 514 staff now and they service an area that is 250km in diameter.
I shouldnt get too excited though but im super excited.
Wednesday, October 28, 2009
Landed in Mumbai
Every sense is overloaded at every moment in Mumbai. People yelling, cars honking, bright lights, more people, boiling hot weather, more people, dust, smoke, and the smell. This is heaven.
It’s not a bad smell either, but you notice it the moment you leave the plane. It will stay with you while you are there and remain for a few weeks after you come back. Your clothes will have it whether you wore them or not and the clothes you bought there will have it for longer. There is nothing else in the world like it, the best way I can describe it is a mix between the smell of the pages of a dusty old book that was read to death in the 60’s but hasn’t been touched since, and the smell of your clothes after spending a night by a campfire.
Another thing that struck me as funny was that people don’t only enjoy the sensory overload but they thrive on it. Most westerners will wear a plane white or brown shirt to work or something like that. The average Indian man on the street seems to reason that “why spend all that money on a shirt and get only one colour when I can spend the same amount of money and get ten?!!” When trucks back up in Australian they beep to warn people behind. Indian trucks don’t beep, they play the latest Bollywood hit or some classic Hindi song at full blast. Drivers don’t honk their horns to warn of danger, but instead to say hello, goodbye and every word in between. On the roadside people dance to a symphony of honking, ghetto blasters, drums and the sounds of life in general. Twice on the way from the airport our cars side mirrors were knocked forward by another car and had to be pushed back into place. Welcome to India.
It’s not a bad smell either, but you notice it the moment you leave the plane. It will stay with you while you are there and remain for a few weeks after you come back. Your clothes will have it whether you wore them or not and the clothes you bought there will have it for longer. There is nothing else in the world like it, the best way I can describe it is a mix between the smell of the pages of a dusty old book that was read to death in the 60’s but hasn’t been touched since, and the smell of your clothes after spending a night by a campfire.
Another thing that struck me as funny was that people don’t only enjoy the sensory overload but they thrive on it. Most westerners will wear a plane white or brown shirt to work or something like that. The average Indian man on the street seems to reason that “why spend all that money on a shirt and get only one colour when I can spend the same amount of money and get ten?!!” When trucks back up in Australian they beep to warn people behind. Indian trucks don’t beep, they play the latest Bollywood hit or some classic Hindi song at full blast. Drivers don’t honk their horns to warn of danger, but instead to say hello, goodbye and every word in between. On the roadside people dance to a symphony of honking, ghetto blasters, drums and the sounds of life in general. Twice on the way from the airport our cars side mirrors were knocked forward by another car and had to be pushed back into place. Welcome to India.
Hong Kong
I couldn't help but constantly search for a sign of oppression or trampled freedoms or underground protest. My distrust of China's system of government is so great that rather than appreciate the lively and bustling city I managed to convince myself that any apparent freedom was an exception to the rule. And the fact that it was an exception only proved the rule. That China was not free and therefore I could not like it. Unfortunately, or rather fortunately, our old friend reality gave me a sharp slap in the face.
I arrived at Central station and made my way to Central pier as the sun was rising. Hong Kong is the tallest city in the world, and while standing at the pier on Hong Kong Island even the cockiest New Yorker couldn't have disagreed.
It was forged in the peak of imperialism, when the high brow aristocrats of Britain truly believed that it was their god given right to bring civilization to the swathes of the worlds barbarian masses. We are all well versed in the dire consequences this had in most of the world, but strangely enough it actually worked pretty well here. For one thing, even though they suffered at the hands of the Japanese along with the rest of China they were protected from the further insults of the communist revolution and five year plan crap. Then, just as China is getting its feet and laying the foundations of its growth explosion, Hong Kong switches sides. But enough of the history lesson.
Something I found amusing is that Hong Kong has few street side shops. Instead of footpaths there are elevated walkways and instead of being able to leisurely stroll the city there is death by uphill walking. The malls are everywhere and packed with every western brand name you can think of. All very boring for someone who has no money. But then, just as if it wanted to prove that it was a western city, I stumbled across China town, a must have of any truly western city.
Maybe I had been slightly racist to think that China would just be like Chinatown but on a larger scale, but it also seems ridiculous to me that Hong Kong needs a China town to remind the average citizen of their roots. The area is Wan Chai and it’s full of street vendors and street markets selling cheap clothes and good food.
And that was it. Just as it was getting exciting and the city was coming to life I had to leave. Next stop India.
It appears that all indications point to me liking this city. Its not love, like it was with Vancouver or Montreal but in one day I’ve decided that it’s like at first sight.
I arrived at Central station and made my way to Central pier as the sun was rising. Hong Kong is the tallest city in the world, and while standing at the pier on Hong Kong Island even the cockiest New Yorker couldn't have disagreed.
It was forged in the peak of imperialism, when the high brow aristocrats of Britain truly believed that it was their god given right to bring civilization to the swathes of the worlds barbarian masses. We are all well versed in the dire consequences this had in most of the world, but strangely enough it actually worked pretty well here. For one thing, even though they suffered at the hands of the Japanese along with the rest of China they were protected from the further insults of the communist revolution and five year plan crap. Then, just as China is getting its feet and laying the foundations of its growth explosion, Hong Kong switches sides. But enough of the history lesson.
Something I found amusing is that Hong Kong has few street side shops. Instead of footpaths there are elevated walkways and instead of being able to leisurely stroll the city there is death by uphill walking. The malls are everywhere and packed with every western brand name you can think of. All very boring for someone who has no money. But then, just as if it wanted to prove that it was a western city, I stumbled across China town, a must have of any truly western city.
Maybe I had been slightly racist to think that China would just be like Chinatown but on a larger scale, but it also seems ridiculous to me that Hong Kong needs a China town to remind the average citizen of their roots. The area is Wan Chai and it’s full of street vendors and street markets selling cheap clothes and good food.
And that was it. Just as it was getting exciting and the city was coming to life I had to leave. Next stop India.
It appears that all indications point to me liking this city. Its not love, like it was with Vancouver or Montreal but in one day I’ve decided that it’s like at first sight.
Saturday, October 24, 2009
Before I leave
A quick word before I leave.
I've been to India several times before, but never to work or live on my own. I feel that the India that I saw was always viewed through a closed window, with me on the inside. My family, as well meaning as they no doubt are, have somewhat coddled me on my trips which is why I am curious and eager to discover for myself the real India.
I have my preconceptions. Viewing from a far I have on several occasions defended India and sung its praises, portraying myself as an expert on the subject as many will know is my style. I am proud of its history and aware of its chaos and contradictions, but to me they only serve to add to my curiosity and interest. Never have I seen such a working disorder, and for a relatively disorganized and 'off the cuff' guy I expect to feel right at home.
Inextricably linked to any new discovery however, is an element of risk. A blank slate has unlimited potential and although we have a thirst to fill it with knowledge and new discoveries, every time we do there is a little less blank space left. The mental image of India that i have and the expectation of what it is has greatly influenced my life. I was born and raised in an Indian household with India values (whatever that means) speaking an Indian language and with mostly Indian friends. Undoubtedly much of my mental image will be wrong and much of it will be revised, the expectations will either come to fruition or be discarded and a dream will be replaced by reality. But the risk is this. What if reality is a bitch?
What I discover about the motherland, what I learn about life in an Indian hospital, and the journey I have in the process will be the subject of this blog. I hope you enjoy.
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