Tuesday, February 24, 2009

The Best for Last

Today could have easily been our best yet! We joined the World Vision Outreach organization for a day of health/vision screenings in the surrounding villages for children that are sponsored. We went to five villages all in the hill areas nearby. Winding gravel roads with very sharp switchbacks made us glad that we were in an SUV with an obviously experienced driver. While this is the dry season and much of the landscape is brown( the rainy season in July and August turn everything lush and green), we were in awe of the beautiful scenery that the villagers are undoubtedly accustomed to. At the first couple of villages, there were many children to be examined so we rushed in and out of the school buildings that housed our make shift clinics. At the last couple we ventured down the main street of the villages greeting kids and giving them starbursts and skittles. Hannah and I felt like we had stepped into a National geographic picture. In fact, before coming to India, I had read in a national geographic about government sponsored village health workers who help with pregnancies, childbirth and immunizations. We were fortunate to meet a lady who does exactly that for her village. These excursions are very important for the hospital because many of the villagers would never venture away from their homes in search of medical care. However, after becoming familiar with the community outreach team, those who need referrals to the hospital are much more open to the idea of making the trek to Kothara which is by bus.
While we took many pics, here are some of the scenes that captured our attention: children hiking/running down a steep hill with water jugs on their heads on their way to the community well, an infant swinging in the breeze in a homemade hammock near the edge of the cliff. We were invited to one home to see a very sick child who most likely has a genetic syndrome(?), cerebral palsy(?), malnutrition and an enlarged spleen. The infant was lying behind the bamboo hut(that I could not stand up in) right next to the cow and pile of cow dung. We were taken to an outdoor restaurant for lunch. The kitchen was well equipped for all of the local favorites. we discovered that the way to ask for mild food is to ask for "chili light". A couple more villages and we were headed back down the switchbacks more tired than we had realized. I watched as we passed by many women and children carrying loads on their heads. I couldn't help but think of the story in the bible that says that not one sparrow falls to the ground without God knowing so how much more valuable is each person to him! While many of these children will never venture beyond their place of birth their whole lives, the value that they hold in the mind of God is unimaginable.

Monday, February 16, 2009

tasty travels!





There is so much to share! We have ten work days left here! We have become pretty close to Mitalee the counselor/social worker. We have set her up an email account and facebook to attempt to stay in touch with her. She seems to do everything/anything that is needed. She leads devos, facilitates church and any other meeting that occurs. She teaches the children's Sunday school. Her work ethic is amazing. While, her duties keep her busy seven days a week, she is happy to serve in all these areas. At the hospital, she stays until the last patient is seen because her job is integral in every patients visit. Most would not know how to open an eye drops bottle or how to put in eye drops if she did not show them. I hope that we are an encouragement to her like she is to us!
Hannah and I ventured out into the unknown last week. We have spent just about every hour of every of every day within the confines of the hospital compound. Pastor Silas the father of the bride of the wedding that we attended took us to our "luxury" bus Thursday night at 8. He got on with us to make sure we got situated and confirmed with the drivers where we were headed. I thank my dad for teaching me resourcefulness. I rigged the curtain closed to that we could have privacy in what I call our "cubby" of a matress with enough ceiling room to sit up but not quite enough leg room for me to stretch all the way out. Mostly bumpy and surprisingly chilly, we slept most of the way to the city. I woke up and started packing up my things to find that there was a gap in the top of the curtain and a little Indian lady just watching every move that I was making from the bunk above and opposite ours. Even with my pseudo brown eyes, I am quite the spectacle.
We rode auto rickshaws to all our stops in the city and managed to book a hotel for the night and find the bust to Ellora. The latter was not as simple as we had hoped. We naively thought the bus stop would have soemthing written in English since that is were manyu tourists make the trek to the caves. Thankfully we discovered bus lane 8 was the one we wanted...waiting...being stared at....finally, a man comes up and questions Ellora? The bus was about to leave but we would never have known cause it was behind several in lane 8.
We found people to be really helpful like that man. If anyone was too helpful, I was of course skeptical with my pepper spray at easy access and was prompt to loudly say "nay" and keep walking. Hannah got a kick out of how bold/rude that I can be if imposed on. I guess my brothers would be proud.
While we left the caves with tons of amazing photos and a new appreciation for the hard work of thousands of men who carved the temples out of the side of a mountain - quite insane actually, my favorite part of the trip was eating. Still trying to learn Indian cousine, we made excellent choices and enjoyed it all - even with a mouse making himself known at one of the "hot spots" for north indian food. I managed to have a veggie cheese burger, fries(finger sticks), and a coke for lunch on Saturday- wooohooo!
A stop at a coffee shop - cafe coffe day- made us equally excited and after searching for the location for two days ( most streets are not named and we only knew the district it was in), we really got the most out of our time to chill in the a/c. Our dinner on the way out of town - ob valentines day- was by far my fave. Buffet style and at a fancy hotel, we felt like queens savoring every bite and appreciating variety like never before. The icing on the cake for that dinner was the guitar/harmonica player who meandered thru the tables playing relaxing music that hannah quickly pointed out to me was songs that we know and love - hymns! We instantly knew we had a lot in common with him. Minorities in the religious hodge podge that India is.
We are happy to be back to work especially since out job description has changed a bit. We help with physio, lab draws/iv's, and only pop into clinic with unusual cases. I am a hands on person so I was glad to poke and prod a man (to body map his deficits) who came into physio post stoke and neglect of his left side.
He will be coming twice a week and the PT tells me there are signs of at least partial recovery - yay!
More later and Hannah is working on a super long post that will be done one of these days:)

Tuesday, February 10, 2009

The Light in the Darkness

I am grateful that I have a firm belief in who I know and believe is Jesus the Christ, who the angels announced would "save his people from their sin". Last week, we were seeing patients for the usual high blood pressure and diabetes when a little old man came in with no different complaint than most of the others. He was here for his blood pressure reading and to see if his diabetes meds needed any tweaking. Speaking Hindi, he suddenly got excited while he was talking to the doctor. We looked at her inquisitively because he was smiling and waving his hands in the air while he went on and on about something that obviously was important to him. The doc responded to our nonverbal inquiries by telling us that he was a hindu pundant or teacher. He had practiced Hinduism his entire life of 81 years. While coming to the hospital for his medical check ups, he had noticed the Bible verses on the signs and asked for a bible. He was given one in Marathi, the local dialect. He had gone home and started reading it. At this visit, he asked for one in Hindi so he could understand it easier, but he loved what he could understand. His waving of his hands had been to express the bright light that had came on in his life. He has never ever felt the joy that he has since discovering the purpose for the world and the God who is the real God. He went on to say that the gods that he had followed only wanted food offerings and such and would never respond to its followers-they were dead. The God in the Bible however worked in the lives of his people. He wondered how he could love so long without learning of this! He visited with the docs some more and he left with his new Hindi bible in hand. Later, we learned that his wife is an invalid whom he was the primary caregiver and she was still Hindu but he was determined to go home and read to her the Hindi bible so that she could share in his new found belief. He was going to maintain his teaching duties because he feared the consequences of conversion. Wow. God truly does draw men to himself where hi is lifted up.

Friday, February 6, 2009

things i love and could do without

Nice! I could keep this up....
  • wearing chacos everyday to workall the colorful saris that the women wear
  • cute indian children that just stare at us and say "good morning!" when we walk by their school at 4pm
  • roti - the flat bread that i eat 3 times a day just to feel full but hey i still like it. today we melted cheese on it!
  • our gas stove that we light with my lighter that I got through all the airports in my carry-on
  • the namaste greeting that patients give us everyday on rounds - they are so grateful for attention
  • not fixing my hair or washing it for that matter...saves on shampoo too! but this is no surprise to any of my loved ones!!!
  • my i pod dock that i bought the day before we came. we couldn't have gotten along without internet, tv, or phones in our house without it! ("The heart of Life" hien)
  • open windows - 24/7
  • the slow pace of life
  • my cocoon silk sleep sac that i swear i am going to use even when i come home
  • our neighbors - who are like the family we never knew
  • the badminton court
  • tea time BID
  • living, working, playing with my friend hannah
  • the lemon and lime trees outside
  • bible study
  • yoga
  • hannah's singing and dancing shows that are just for me!

really? must this be so???????
  • ants that swarm our kitchen table, sink, everything else
  • hindi obnoxious music blasting outside
  • the smell of ten bodies in one exam room without ac but with infectious skin disorders that smell and kids without diapers and untreated tb patients breathing in my face as i auscultate their cavitary lungs
  • nonsterile technique...somebody please wash your hands
  • eating lunch at 1:30 - don't you know i need my snacks
  • lack of food variety...i learned that if i blend their rough sugar into a fine grain that i can add it to absolutely everything!
  • hand washing all my laundry - well at least i get some kind of physical activity
  • the smell of mothballs
  • nightmares from our malaria medicine - watch out for the men without heads
  • the heat that is creeping into our days
  • we know how to treat this illness, we just don't have what we need to do it
  • while the slow pace is a nice change....sometimes things just dont get done in the same week that you need them to....PTL for wireless though!!!
  • the monkeys that think our roof is a jungle gym at 5 am!!!

Thursday, February 5, 2009

Bright Eyes and the most contagious smile

Saturday's are nice because they are half workdays. India is different from the US in that school and work are usually six days a week - one reason to be glad that I went to school in the states. Last Saturday, a young father brought in his four year old little boy for examination. Looking at him I was somewhat surprised that he was four because he was the size of an average two year old. One other feature was alarming in such a small child - he had massive ascites causing his little belly to be totally distended and tense. He was breathing rapidly and would cough intermittently. Being a small hospital with only xray imaging in house we sent him to have an ultrasound at a nearby clinic. Today father and son returned with the report was brief and handwritten on a folded piece of letterhead. Liver masses with blocked portal vessels. We have no other investigations at this point and his history is only significant for ascites starting in the first week of life! He is a bright eyed sweet natured little boy who was staring intently at Hannah and I. We immediately grabbed our cameras and took pictures of him as most kids love seeing themselves on the digital cameras. His smile blew us away and he even started laughing in a high pitched little squeal. We worked hard to distract him with finger puppets from the procedure to drain the fluid from his belly. After several hours we only got a little fluid to come out. We have no way of knowing the prognosis since we have no idea what is growing in his liver. As father and son left the clinic, the father could not keep back the tears from flowing and soon the little boy's flowed too. We hope to refer him to a University hospital where the facilities are better suited for diagnosis and treatment. For now, all of our hearts are heavy as we think of the little ones in our lives and how dear they are to us and how helpless we feel toward this little bright eyed child of God.

Thursday, January 29, 2009

World Leprosy Day

Today is world leprosy day. Many places that normally don't think about this disease will be raising awareness and support for these patients. Here at TLM everyday is leprosy day. While we had a special presentation about the history of the disease and the decline since the implementation of multi drug therapy, rounds are the same - monitoring the healing of ulcers and improving lesions and joints with therapy. I am concerned about one of our patients that I also saw in clinic on my first day. We admitted him for a deep plantar ulcer. After two debridements, it has not improved. After an xray it showed bone involvement. Monday we will remove the right big toe from this 25 yo. He is in college and seems very smart. This operation will help his current ulcer to heal but with altered anatomy, he will be more likely to get ulcers in the future. He will have to pay close attention to his feet. I am hopeful that since he is so educated that he will understand the importance of prevention. Most of the other leprosy patients are not so thoughtful. They are counseled over and over but don't seem to have the forethought to take care of their dry, fissured feet before an ulcer devolops. Pray for the counselors and PTs as they have the most difficult jobs in training patients and please pray for my patient's ulcer to heal with the operation that is performed. I look at my feet which are very comfortable in my Chacos even if they are dusty from the dirt roads and I am thankful that they tell me when I have a rock in my shoe and how to balance my weight just right so I don't have too much pressure in one area. Look at your feet...and be thankful.

Wednesday, January 28, 2009

Pics

We were so excited to have fresh fruit. This is a papaya that we combined with bananas, apples and grapes and had an awesome fruit salad. Notice my Indian shirt:)
Here is am with my sweet patient with type LL leprosy right after the second debridement.


Here is the campus kitchen. This is the room that the rotis are made. The lady on the left makes hundreds of them. They are very tasty. The lady on the right - Monkarna is one of our cooks. We like her food the best. She speaks some English and loves Hannah and I. They are cutting the veggies with a "knife" that they ancher with their foot.

Here's the Taj in Agra..we have professional pics that have Hannah and I in them but not digital so we can't upload them.
Well, hope that gives ya a quick snap shot of life here in India. Take a look at Hannah's bog to see more!



Saturday, January 24, 2009

Giddy is Gone

So after two days of dressing changes, it was time to debride and cut some more of the dying toe off. This time I was able to make it through the whole procedure without any quiziness! My patient was later that day diagnosed with the most severe form of leprosy due to her stopping her treatment too early back in 07. She will now have to be on treatment for two years which brings its own set of complications such as skin discoloration and hypersensitivity reactions. She is soooo precioius though. Every time we round on her. She cover hers face with her sheet and just hers eyes stick out above the sheet but I can tell she is smiling by the squint in her eyes. I just go up and grab her hand and give it a squeeze...I think she is my favorite patient now...This morning I discovered that she had not taken her medicines and had just stuck them under her pillow for safekeeping I guess. Patient education is huge here. The doctors don't do much of it because they have hired a full time counselor to sit with the patients and take as long as is needed to walk them through how to care for their wounds, take their meds and what signs of infection would need to bring them back to the hospital. We learned that there are no appointments. Patients arrive early in the morning, line up and get a number. If their number is not called that day they have to come back the next day to be seen. The setting is also differnt. The docs sit at desks and the patients come in to see them. Two docs to a room with a shared exam table that has a screen to give some privacy but not much and often private parts are exposed to all in the room. Even AIDS diagnoses are given in front of all in the room. I am sure my next TB skin reaction will be positive as it is more common than the common cold here. I could recognize a TB chest xray in my sleep by now. Yesterday was the most exciting day by far for me as we got our first exposure to the OR. How different! Hannah's blog goes into more detail but I hope to spend more time there suturing which is much more diffilcult without the right sized needles and when the suture falls out of the needle if you don't rethread it every throw! 
Tonight we are headed to the  market which should bring some relief as far as the monotany of our diet...also we are makeing key lime pies for the picnic on Monday which is a national holiday celebrating the Republic forming. Yay for holidays and lots of food:)

Wednesday, January 21, 2009

BTW...giddy is the indian term for nauseated:)

Giddy

Well it is day three in the clinic. On day one, the morning started out pretty slowly with chapel, rounds and clinic patients. I was seeing leprosy patients and we admitted a couple for plantar ulcers which are very very common. One lady came in with a lion face of a leper. She had started treatment in 2007 but quit taking the meds for who knows what reason since they are free for everyone who needs them. One thing that we noticed right away is the smell that she brought with her into the room. Lokking at her feet we knew that we should leave them wrapped in her cloth and take her to the "casualty" or ER for a debridement. I was the lucky operator. I am getting nauseated just writing this. Her big toe was about half gone and the rest was necrotic all the way down to her mid foot. I was instructed to cut and pick until fresh skin could be seen. As I began to dig, I noticed that what I was pulling out was actually tendon and bone along with the granulomatous tissue. She seemed to be in pain which made me hesitant to proceed. I was assured that she cold not feel it and that her groans were more psychological than actual pain. As I dug deeper, I began to feel sick. I just tried not to think about what I was doing and get through with it. I had to brace myself as I was digging deeper. When my gloved hand touched her foot and all I felt was mush...I couldn't ake it any more. The room became dark and quiet and I knew I had to sit down before I fainted. Thankfully everyone was sympathetic and patient with me. I was sick all evening and went to bed early. We have rounded on her twice since then and she is so grateful to me for "torturing" her. We will restart her on leprosy meds and teach her "self care" which includes SSO or soaking, scrubbing and oiling their feet. THey don't sweat so their feet get cracks and fissures and ulcerate and infected. I know her smile including her only two teeth is one that I won't forget.

Saturday, January 17, 2009

Holy Cows!

We landed in Nagpur and our excitement was building by the second. We were greeted by two gentlemen from the hospital and a bulky red SUV that served us well on our four hour drive to Kothara. The drive was an amazing one. The city of Nagpur is also known as the city of oranges. The whole drive was lanscaped by orange groves here and there. About halfway here we started seeing mountians that remind us more of northwest AR than the rockies but still a lovely backdrop to the fields of wheat, cotton and of course oranges. While we had heard about how animals tend to have the right of way here in India and we saw a few on our drive to the Taj, we were amazed at how many cows just stand in the road and don't move an inch for the traffic!!! The whole drive we kept seeing small heards of cattle with ir without their "shepherds". At times, we had to stop and let the cows, sheep, and whatever else decided to dominate the road have their way. Well, that was our journey here. We are nice and settled in our house right next door to the doctors who are the directors of the hospital. In fact, I am in their house using their computer for this post:)

Thursday, January 15, 2009

A family for a day

Hannah and I made the trip to the Taj yesterday! Our trip consisted of the two of us, another american from conneticut who sells helicopters - cool, and a austrian also here on business and our Indian driver in a nice Toyota SUV. We had so much fun seeeing and sometimes laughing at all the interesting sights along the road during our 4-5 hour drive each way. Drivers here receive money from shops for bringing tourists there so we made several stops doing this. While we could have refused, we just enjoyed getting out of the car.
Our driver did not speak much English at all. At first we thought he was telling us that each shop was his shop. Until we realized that he procedes everything with "my". Here is my hotel, my picture, my fort... he would say. I could not stop laughing at what a lack of communication can lead to...because we really did believe him at first. It also reminded me that I should try to understand the concept of what people are saying and not just the words...handy idea when it comes to medical care where miscommunication is more costly.
At the Taj, security was "tight". Greeted by armed guards and security check points was expected. We knew we could not take electronics or food so left our i pods and snacks in the car with our driver. I did not know that I would still break the security rules. There is a separate line or queue for women. While being felt up for secret weapons another female guard carefully went through my bag. I could tell she was more curious at what everything was. She played with my pepper spray that I had left on the outside of my bad but thankfully it did not fire and she just left it alone. Then she found my National Geographic that I had been reading on our car ride. This is not aloud she quickly states. I was in disbelief. She started flipping through the pages immediately while I was still standing there. I was confused since I had my bible and other reading material in my bag as well. I refused to let here keep it and my guide had someone outside hold it while we toured. Coming out I found that they had been passing it around and did not want to give it back. I did get to take it with me but with a greater appreciation of what I possessed! Who knew how much of a ruckus that would cause!!!

Tuesday, January 13, 2009

Jet Lag???

Just a quick note before breakfast but more to come soon...
We made it!!! It is now finally starting to seem like a reality that we are in India. As I sit and hear the busy honking of horns, smell the fog/smog that fills the air and woke up to chanting from a near by temple, it is for real. Hannah and I slept in a clean and comfortable quite spacious room. We are provided breakfast and have a pretty fast internet - it might be faster than my struggling computer back home! Well, it's Hannah's turn to update:)

Monday, January 12, 2009

On the Road

NYC: We are taking advantage of our 9 hour layover. Hannah's good friend from college Sam just moved here. She is taking us to the MOMA and a few choice eateries too. I love all of the diversity. I would be happy just people watching but off we go:)

Sunday, January 11, 2009

Still in Arkansas

Yay! This is going to be such an adventure!!!!! Today my goal is to "forget" all the things that make me worry - like school and residency. I am going to mentally chill. I have been putting my stuff into storage and have noticed that I accumulated so much...stuff. I have also been packing for my trip. Guess what I am taking...stuff. While living without anything is not an option, I am sad about how many things I own that I don't use or need. So, I decided that my new goal is to simplify. I think that going to work in India will be the perfect setting to find out what that means.