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The beauty of water

Splish splash

Waking up this morning was not too fun after such an eventful and late ride home, but you can’t really come up with an excuse to miss church, especially when three other people are going with you. The best part of the mass is how the priest connects the reading to the Indian culture we are in. The message is the same, however the approach he takes is very different from that in the states. After church we ventured on the reservoir hike again. This time it went a lot faster, but we almost got caught on the hike. We aren’t exactly welcome there, but if we walk next to the falling tree and no one hears, were we really there? The refreshing water was well needed after the car ride home yesterday. Right after we got out we had to get out of sight of the officials checking the water and we ate snacks and took a nap behind the bushes. The rest of the day was very relaxed. We went to the market again and got groceries. The group was getting a little heated about certain aspects going on in the house, but I think (mostly hope) everything is worked out for the moment. Our first day in the crèches is tomorrow. I am excited to see the kids, as well as see the exact work we are doing. With the first week in the bag, I could not be more ecstatic for the next seven.

Across the bay from Alcatraz

Morning down the mountain

Car selfie at its finest

Making our first trip out of Kodaikanal was nothing but a fun continual adventure. We left house around six in the morning and very quickly found out that the qualis squished the group a little more than we intended. Some people were still a little worried about the drive down the hill so we came up with a game to play in the car. Before we turned each hairpin turn, which was on the side of the cliff, we all guesses the level of danger that would come from the approaching traffic. A motorcycle was a one, while a large bus coming within inches was an eight or nine. As we got down from the mountain it was as hot as a valley in India in the summer…… literally. I cannot begin to comprehend how people dealt with the heat wave that came a couple weeks ago. After arriving in Thekkady at the Periyar tiger reserve. We took a boat ride through the reservoir through the reserve. After that was the best part of the trip and right up there for the week. As we bought our tickets to ride the elephants we stood at a platform about ten feet above the ground. I did not realize how big these animals were until getting on them felt like boarding a small prop jet. Meera, our elephant, took us up and down the hill and helped pose for a couple pictures here and there. The experience was something I have never felt before, but I would not want to be anywhere near those huge creatures when they stampede. For dinner we went to a restraunt in the town close to the reserve. I am still getting used to how the meat is made here, so I did not eat much. The chicken here is just chopped up into pieces, bone and all. The rest of the evening was easy, besides the overheating car, slightly lost driver, and nauseous people in the car. The car even came with a free sauna in the back seat, sweat is complimentary. Getting back at eleven, the seventeen hour journey was beyond worth it.

Riding Meera

A beautiful boat ride

Manly men

Baby and the momma

Welcome to Pasam

This morning started by checking on the patient from yesterday’s surgery. Although the wound was still in some pain, it looked very clean and intact. Instead of using a plastic tube to set the drainage canals within the sutures, Dr. Mas used a slice of a glove in two places. At first this seemed a little unorthodox, but this technique is used in many places where supplies are limited. The rest of the Friday was quiet until I saw one of my favorite patients come in. I have not asked his name, but he brings out inspiration in me every time he steps in the door. About five years ago he had a stroke in the left side of his brain and was not able to walk or do any daily activities. From going to physical therapy for about a year and a half, he is now able to walk 5 km a day and is talking more than he ever has. Alex and I were given the opportunity to use the exercise ball to work his legs and arms and the scene was unbelievable with him using his own muscle to kick the ball and being able to move his arm enough to get the ball rolling in the right direction. Before seeing his improvements, one would not imagine anyone in these conditions could recover from paralysis in one side of the body. I now see that with the care of others and some long dedicated hours, anything is possible. His face turning form a frown as a walks in, to a sparkling smile when he leaves is something no money can make happen. The radiance comes from the care and generosity of others. The will to never give up by not only him but all the doctors involved as well. This car and compassion must be institutes in every patient, making their individual wellbeing the most important job at the moment. I am very excited to see how he comes along in the weeks I am here, and will carry this faith in resiliency into future cases that look to be “impossible.”

The imPOSSIBLE

My favorite stray dog Shakespeare

Another morning in the clouds at Pasam Trust

“There can’t be more,” is what I thought to myself as I was throwing up in the bath room at the clinic. And…. Yet more came. My first experience of traveling abroad I guess. But after getting it all out of my system, literally, I felt much better in the evening. I sadly missed a very interesting surgery where Dr. Mas removed a lipoma mass from a patient, but I hope to see more in the weeks to come. Some of the students were upset with the lack of sophistication in the surgery based on our experiences of medicine in the United States. However, this medicine is all the people have here. The next couple weeks will be eye opening into some of the pains of the health care system in India. My responsibility as a student will be to look at the system as a whole, and figure out all of the lessons I can learn each and every day. Goodnight from the tropics of India.

Lipoma removal surgery

Pulling out acupuncture needles

Daily tea with Dr. Mas and company

Today I was able to take the vitals of many patients that came in. I became very comfortable with interacting with the patients as well as communicating what I needed from them across the language barrier. Soon into our shift Dr. Mas explained his approach to treating patients “In order to get rid of the pain permanently, we must treat the cause of the pain and not just the pain itself.” This concept is not nearly addressed enough because many relate instant pain to the injury or problem at hand. However, the locals of Kodaikanal are so used to dealing with aches and pains on a regular basis that what feels like excruciating pain to many Americans, would feel like a mild pain to these people. In addition, middle class Americans have access to frequent doctor and pharmacy visits to follow up with a check-up and more medication, compared to the one doctor visit a local family will make every couple years. Given these facts, the patient must be proscribed a medicine or treatment that efficiently targets the source of the pain and not just the pain itself. Jodi, a physical therapist from the States, has been using acupuncture on the patients to alleviate their pains and to fix problems such as pinched nerves. The Chinese acupuncture Jodi has studied uses deep needles that penetrate the body in order to allow chi, or energy, to flow through the body. The energy flow through channels or meridians that have certain gates throughout the body. When the needles are inserted into these gates they allow the chi to flow freely, relieving the pain and pressure in certain areas. Some may argue that this is not an effective medical treatment, but each patient walks away saying they feel much better, and the number of patients coming in specifically for her to treat them has been growing continuously. Although this may be an effective treatment in the US in an impoverished placed such as areas of Kodaikanal where people are working all day every day and hospital visits are rare, an acupuncture routine may not be appropriate. Decisions such as whether or not to use acupuncture in the regions hospitals come up a lot. Theoretical effectiveness versus the reality of the treatment must be assessed based on the culture and resources. The ride home from the hospital was accompanied by procession taking place through the main streets of Kodai. The participants had very elegant face paint, were holding baskets on their heads, and holding pots that encased an open flame. The festival is not popular outside of Kodai, and therefore I could get much information about it. Saying all of this I would like to point out that I do not mean to bash my beloved country in this post or any after this. I am simply trying to point out the differences in how a doctor must practice when coming from to States to somewhere like Kodaikanal. Even though the goal of healing the people we are treating to the best of our ability is always in sight, the process of getting there may be completely different. On that note, good morning to the West and good night from the East; may your day be as happy as the patients when they leave.

The group observing Jodi removing needles

Festival through the town streets holding flaming pots

Festival continued

Forest beyond forest

Wrapping a broken toenail

Today was a slow day at Pasam Hospital (spelled Pasam not Posom as I spelled it in my last post) due to the fact that Tuesday’s are a religious days for most Hindi’s in the region. I was able to get more involved with the patients that did come into the clinic, helping Dr. Mas by taking vitals and putting on basic wraps. The fortunate thing about the clinic is that there are not strict governmental rules about what student volunteers can do compared to the United States. As long as the doctor feels that I can appropriately treat the patient, he will allow me to perform the procedure necessary. Though this is usually at most a splint or an injection, I look to gain comfort around patients so I will feel natural when I have to perform more invasive procedures. An additional concept taught was how to properly clean a cut that needs dressings applied. In the United States, most people would know to wash it regularly and put some sort of antibiotic ointment on the cut to prevent it from getting infected. The conditions for many of the locals do not allow such treatment and therefore when a patient comes in with an old wound that wound must be debrided, which is removing the dead and infected tissue from the wound. After the clinic we took a short walk of about three miles up the road through the forest. We were greeted by about thirty monkeys and they all wanted food. When John gave a baby monkey a small piece of chocolate they all looked intently at him and got very close. Their comfort with humans is understandable with all the tourists but is still unusual to me. The night ended with another spicy Indian dish that included rice, flat bread, and a spicy vegetable soup. Tomorrow is a busy optometry day for the clinic, and I will be helping Dr. Mas with many eye exams. Until then, it is farewell from Southern India.

Monkey eating corn on the cob

Moon above the mountain

Dr. Mas’s exam room

Sun pushing through the darkness

The first day in the Pasam (affection in Tamil) Trust Hospital started with the cutest boy that had idiopathic toe walking, which could be seen by how he only walked on his forefoot and the unnatural curvature in his foot. He could not have been a better child to have as the first patient. His smile sparkled and he could not help but to laugh at everything we said and did. We decided on creating a splint out of some material we had in the clinic because nonsurgical treatment is naturally the most reasonable solution. But when we tried to send him home at first he did not want to leave. His inclination to stay made me realize even more that the people that come to this clinic do not have regular healthcare. Treating them makes the kids feel that they do not have to constantly be in pain, and the low cost of the clinic allows for the parents to afford to bring their kids to the hospital. The couple of the doctors there were explaining that less people have been coming in since they have had to pay small fees compared to when it was free. The fact that it now costs a little fee is unfortunate for the people that cannot afford the cost, but without the small fees the hospital would not be sustainable in the long run. The numerous amount of volunteers and doctors that take low pay that work in the different hospitals around Kodaikanal make the health centers more affordable and accessible to the impoverished. For dinner Babani cooked us idly and samber, which is a traditional Southern Indian dish consisting of steamed rice cakes and a spicy vegetable soup. She only makes vegetarian dishes, which is beneficial to our immersion into the culture here. And to be honest, with all of the tourists in town from northern India there is plenty of meat at lunch time. Today the sky poured like I have never seen. Standing water started to form in the streets in a matter of minutes and water was draining for hours after that. Geena worked at Munchees, a place we like to eat at, and she said that once the rainy season starts it doesn’t stop. Nothing like experiencing southern India when the sky never stops falling. I will continually try to balance medicine with Indian culture in future posts and be sure to leave any questions or comments you might have. நன்றி (Thank you) for reading and துங்கு (goodnight) from Kodai.

Upstairs exam room in Pasam Hospital

Downpour in Kodai

Reservoir on the morning hike

This morning started with taking half a shower. I will definitely learn how to efficiently take a bucket bath in the next day or two. We went to church at a Catholic church in town. It was in English and very enjoyable. The mass was a lot more relaxed than the traditional church at home, but everyone was very kind and inviting. We have a group of four of us that will be going to church for the eight weeks we are here. We went on a hike through the woods up from the FIMRC center. The locals don’t like “outsiders” in that area because it is their drinking water, but we were able to go and when we walked far enough swim. The area is completely quiet, besides the constant honking that comes from the roads that are still relatively close. On the way back we saw monkeys climbing on all of the buildings through town. All the animals are very friendly with people. In town we went to the Tibet restaurant, and then went through the market to get vegetables for the house. The market was very bustling and I did not know much of what people were saying, but Arun said we could manage in English so I will have to check it out another time to buy my own goods. Tomorrow we start our work in the clinics.

Half of the team

Monkey on the railings

FIMRC guesthouse and clinic

Arriving in India was a slight mess, but not counting the bag not getting through to the Chennai airport and having to run through the Abu Dhabi and Chennai airports, the journey was not very difficult. We were picked up by a driver that without a doubt made it feel like we were in the India 500, just also through traffic, people, and of course the cows and goats. It took four hour from Coimbatore to Kodaikanal and the drive was spectacular. I rode on the back of Arun’s motorcycle which is always exciting. My first meal was Tibetan food and the second American; Arun is definitely just trying to get us acclimated before we dive right into the Indian food. He says this is the biggest group of volunteers he has ever had so it should be interesting to see how everything plays out in the next eight weeks. Everyone was pretty tired throughout the day, but we managed to get to know everyone and I feel like the group is going to be very close by the end of the time here. The day ended with going to the “hotel” room and realizing Alex and I will have to share a bed for the next couple weeks, the showers are bucket baths, and the toilets use a sprayer instead of toilet paper. Welcome to India.

Road sign for Kodaikanal

Hello from India,

As most of you know I will be working with FIMRC (The Foundation for the International Medical Relief of Children) on a medical volunteer trip in Kodaikanal, India. I will be here until the end of July and will be blogging about my time in the clinics and crèches, as well as about my adventures in India. I hope to gain experience in the clinical aspect, as well as an understanding for the healthcare systems in places with little resources.

Thanks for following my journey and I will be sure to keep you informed,

Tony

Kodaikanal in relation to India