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.
Wednesday, November 25, 2009
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.
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