Washing hands at Nathanael Crèche

It has been awhile since I have blogged due to my Northern India Trip and being busy with last minute activities. I’ll talk about my trip to Delhi and the surrounding region this weekend. This last week I was able to spend time in Nathanael Crèche during the morning. Having the opportunity to see how the kids learn and play each day was very revealing as to why the crèches are so critical to the children’s development. First and foremost are the teachers that work in the preschools. These ladies are discipline the kid’s more than I have witnessed. Whether it be straightening them out for fighting or not staying in line, the place is run like an army camp in some instances. But when a child is down or they need a mother’s care, the ladies do all that they can to bring happiness and encouragement to the kids. The balance between the discipline and love the kids receive is remarkable and can only be given by people that give their heart and soul to the children.

The Pasam Trust Crew

One of the nicest nurses at Pasam

Dr. Susheel

Group picture with the amazing Salene

Today was my last day at Pasam Trust and my last day in the hospitals altogether. Although the hospitals were not as busy as I expected, the experience was unforgettable. After spending so much time with Dr. Mas, Raja, Dr. Arun, Dr. Susheel, and the nurses, it was hard to believe that I have to just pack up and leave. I am not sure exactly how many patients I was able to interact with, but the number of lives I saw changed by just a stethoscope and some medicine was astounding. Being able to impact lives so directly is something not able to be done in many other professions. Working with the patients has filled me with priceless medical perspectives and lessons learned, as well as motivation that will carry me through any obstacles that arise on my way back to these patients. Helping them is a dream, and partially a responsibility, in my eyes.

Outside of Pasam Trust

After a weekend of corn to celebrate the independence of America, it was back to work in the clinics. This afternoon in the rural clinic at the guesthouse, a patient came in with a highly infected finger that had a very large cut. He is a daily worker at a construction site and did not bother to take off his bandage for a week. The outer layer of skin was yellow, probably dead, and a hindrance to the healing. We decided to cut off the dead skin, revealing the bright red new skin, which indicated blood was flowing through the ceiling. He was bandaged up and instructed to return each day this week to get a new dressing. Although the clinic can get slow some days, being able to help such a man when most other medical facilities are closed is very rewarding. Today, we were also able to teach English to some of the students at Pasam Trust. Teaching others a skill that will help them in the future is always a wonderful feeling.

The surgery room at Pasam Trust

Wednesdays at Pasam are always busy. But I never realized why until today. Dr. Mas explained to me that no matter what he is there every Wednesday. If he takes any vacation, which I’m sure he rarely does, he makes sure to not skip Wednesday at the hospital. The patients in Kodaikanal and the surrounding villages may have to travel a couple hours walk to see him, and if they come expecting him and he is not there, they may never come again because they feel like he is not reliable. Though it may sound insignificant, the patients trust him to be there when they need him, and that if they need him he is sure to be there every Wednesday. Being a successful physician is not all about the skills or the intelligence, but also being consistently there for each and every patient. In today’s healthcare world, it is all about seeing many patients and getting good ratings. Though in reality, the most important job is the individual patient in a physician’s office at the moment. I hope in the future, I am sure to look after each patient as a unique individual who has fears, doubts, and a history that cannot be understood through a textbook. Only will this allow me to truly impact there life in a positive way.

Cows during the sunset

Today was my first day back at Pasam in a couple of weeks. Having tea with Dr. Mas was nice as he explained how the nursing school was starting out and his thoughts on the status of the hospital. The nursing and technician students that are taking classes are able to get the education at a reduced rate and without having to travel far down the mountain. Many kids will not get an education past high school due to either the cost or the inability to travel very far. This limits their opportunity and in that case they would most likely end up doing daily labor for the rest of their lives. Like many of us already know, offering someone an education and skills to compete in the world is more valuable than any amount of money. The rest of the day I was able to work with the dentist at Pasam. She mostly performed extractions of decaying teeth due to the limited amount of brushing that goes on in many homes. Her approach to the patients is stern, yet very friendly. Looking into the patient relationship aspect of medicine, it is always interesting to see the different approaches that physicians take. She establishes her confidence and intelligence early in the session and carries on with her friendliness and positivity. Making a patient comfortable and confident in your work comes from a strong balance of emotion and intelligence. Without one of the two, a physician’s work may not be as much help to the patient as it could be. Thursday I will be teaching a session of English to the nursing students. The opportunity to get more involved is always appreciated. Until tomorrow, goodnight from Kodaikanal.

The densist’s office

School for students with special needs

A classroom in the special classroom

Today is the first day at the clinics for session two. But instead of the clinics, I was able to go with Arun as he inquired other hospitals and schools about us working there as well. The most impressive and inspirational school was the special school right outside of town. This school takes in kids from all over the town and helps them to develop educationally, physically, and vocationally. School-aged kids are given therapy based on their impairment, whether it be hearing, speech, vision, cerebral palsy, polio, or mental retardation. The school tries to assimilate the students into the regular schools as much as possible, but they are always welcome back if they need more therapy. Some of the teachers are even graduates of the school which revealed the tight knit group the kids form when they are all overcoming the same challenges. The most impressive rooms in the school were dedicated to teaching the older students, and some adults, vocational skills that will give them the opportunity to get a job in the real world. The products made are mainly paper cups, bags made from newspaper, and trays and bowls made from compressed leaves and newspaper. In addition, one women is in charge of the prosthetics department where they made braces and other devices for any disabled person who is in need. The fact that someone started such an institution and found a way to keep the project sustainable is very inspiring. The only way to truly make a difference is to create a program that will carry on through the years, reaching out to more and more people.

Vocational training in the special school

Pillar Rock

Pillar Rock entrace

This morning was my first Saturday sleeping in instead of driving down the mountain at 7 AM or arriving at 4 AM in Puducherry. I went on a run, my first double digit mile run in a while, and wound up finding Pillar Rock and Guna Cave, two well-known gems of Kodaikanal. The views of the valley were absolutely stunning. India still ceases to amaze me with the diversity in landscape, animal life, and culture. Since it was the weekend the monkeys were out as well, because obviously they are working during the week. From stealing water bottles to screeching at the people, the monkeys are more entertainment than I could ever ask for. The best part was being the celebrity of Guna Caves. Since the locals, and even the tourists from other parts of India, do not see white people often, they insist on getting a picture with us anywhere we are seen. After about 40 pictures with the group at the Cave, I had to make the trek back home. After already running 6 miles, going back up the mountain seemed like it would go on forever, but I finally made it. Tonight we attempted to make a bonfire and s’mores, but the dampness of the wood brought that quickly to a halt. Plan B is making chocolate idly so we shall see if we have any more success with this. The session one group is leaving tomorrow, and the session two group will be arriving. I feel like I have been here for a year, even though it has only been a month. I am more than looking forward to the next four weeks and the continuous adventure that keeps me on my toes. Goodnight from Kodaikanal, and have a wonderful Saturday.

Guna Cave entracnce

My new friends

House visits

My favorite puppies

Today the team made house visits around the homes of the crèche we are usually at on Thursdays. Seeing the kids in the crèches is one thing, but being able to see their family, house, and how they live is even more enlightening. Many families only have one room with the stove in one corner, the bed in another, and not much room for anything else. With this setup, the smoke from the wood fire stoves gets throughout the house and creates a very unhealthy environment. Not to mention that the beds consist of a blanket covering a raised metal sheet. Most of the women do the laundry in a running water source close to the house by rubbing them on a rock and the drinking water comes from pipes that run through most of the neighborhoods. Even with these conditions, the kids and parents could not have bigger smiles. Looking at life from a bigger picture, we should all be happy where ever we are at. It is not about being jealous about what we don’t have or feeling guilty about what others don’t. Life is about being happy with what we are given and taking full advantage of what resources we are gifted with. The men and women in some of these houses work six long days a week just to put food on the table. A middle class American should not give up the gifts they are given, but instead work just as hard to improve the lives of the people in these people as they work to put food on the table.

Household surveys

Women doing laundry in the stream

Rooftops of Kodaikanal

Little man Paul

The main purpose of each physician is to help their patients as much as they are capable to do so. Dr. Arun really hit on this point today when talking about his approach to practicing medicine. Since most people in India do not have health insurance, each test and procedure is a burden to them and their family. Even though the diagnosis may take more time, Dr. Arun tries his best to take the tests and procedures one step at a time. This is much different than the United States, where many tests are ordered before the patient even gets a bed. Since many Americans have health insurance, running many tests is not a big burden on the patients, but in many situations “Indian medicine” may be more helpful. What I mean is that when treating the impoverished people in the States, treating them only for what is absolutely necessary will save them money and allow them to not be burdened by their health. Until now I didn’t realize that working in a less developed country could improve my skills for working in America, but now I do. Learning how to work with limited resources is absolutely vital when working with people who cannot afford the resources available. There are so many people around the world that need a little help when it comes to affording healthcare, but just as important are the people in my backyard. The rest of the day in Kodaikanal went as usual, but I do have to say that I am very happy that I found my lunch spot. I cannot complain about getting all I can eat for less than one US dollar.

The view from Joshua

Taking measurements in Nathaneal

My friend Saijesh

The monsoon season made its point today, as the sky never cleared and a drizzle never ceased in Kodaikanal. At KHMS, Haley and I learned a lot about practicing medicine in a trust hospital set-up by being with Dr. Arun. The biggest challenge in taking care of the patients is their compliance, or the lack there of. Deciding on the simplest medicine that has to be taken the least frequent is the best situation. Even if the medicine is correctly proscribed, the patient will not get better if it is not taken as directed. The infections could even become immune to some medicines in the case of not finishing a course of antibiotics. He has also mentioned that charging a nominal fee for medication in a trust set-up can prove to be more beneficial that providing the medicine for free. Although the people have very little money, having to pay for the medicine encourages them to be more critical about taking it. This will have them have to see us less, and will save them money in the long term. As far as lunch goes, so many places are very expensive, and the cheap places do not fill me up. Wandering down the street where the locals hang out, I found Hotel Imran Biriyani. The restaurant barely looked open and I had to walk down stairs though a dirty hallway, but it was the best food I have had here since. After sitting down, with a random guy across from me, they laid down a banana leaf in front of me and served rice, somber, and a bunch of different sides. Eating with my hands is getting so normal that having to eat with silverware is quite a burden. I also got as much food as I could handle until I figured out that I had to say I had enough food before my stomach exploded. It has continued to rain here, but still I am going to have fun playing volleyball in the mud with the men from the observatory. Good morning to the states, and good afternoon from India.

Doughnuts and coffee

Happy children

Sunrise on the Bay of Bengal

The trip to Puducherry started with a perfect example of what “Indian time” is: the bus was scheduled to leave at 6:30 and the last people boarded at 6:40. The bus ride surpassed my expectation, and soon enough we were dropped off on the outskirts of Puducherry at 3:30 in the morning. After an hour and a half of walking we found the beach, and saw the sunrise on the Bay of Bengal. The fisherman in the bay were the most impressive – fishing from small flatboats and jumping in the water to grab every net near the shore. From then we went to daily bread and escaped the heat for at least a little while. After that, I found the freedom every teenage boy wants, which has two wheels and goes as fast as fifth gear. We rented motorcycles and driving in the middle of an Indian city could not have been more exhilarating. The biggest differences driving here is that most people use the left lane, but still, it is only the suggested side of the road. It wasn’t uncommon to see people riding the wrong side of the street. The group then went to the Chunambar beach, where as Americans we were able to swim in the ocean compared to the locals who were not allowed to by local authorities. The water was much warmer than anywhere in the Pacific, and we spent a good half of the day. After having dinner at La Terrasse, we took a drive along the coast on the East Coast Road. Getting out the city and getting to shift through the gears could have been my favorite part of the trip, right up until our next adventure on the bike. Sunday morning I made it to mass at The Basilica of the Sacred Heart of Jesus. Although the mass was in Tamil, I did understand one word as the priest broke the bread. The church was beyond beautiful and was such a nice touch to an already stunning city. From then we ate at a restaurant which had the second best coffee in town – the best is made in each family’s home. After bartering with some very stingy rickshaw drivers, we made it to Auroville. The town “belongs to humanity,” but seems more like a cult. The concept of finding one’s inner self is intriguing, just not worshipping the one they call “mother”. Leaving the small township, Kripa and I stopped to grab pizza for the group. Delivering pizza to the beach is not ideally done on two wheels, or through the rain, or while also carrying backpacks, or on a busy highway in India…. You get the point. We arrived at the beach just in time for the police to tell us the ocean view would be closed soon. So we called it a day, returned the bikes, and headed out for dinner. Making it to the bus on time, we go on and only had to deal with two snoring men, and one vomiting women. The bus dropped us off at 7:30 this morning and we were at the crèches with the kids by 9:30. Getting to see the rest of India is very rewarding since Kodaikanal is starting to feel very small. I ended the first night of the last week of the first session by paying volleyball with some of the local guys at the observatory and found I am not as good at volleyball as I had thought. I hope you had a great weekend. Goodnight from Kodaikanal.