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.

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.

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.

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.

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.