Saturday, February 17, 2007
I spent the final week of my experience in India working on my yoga "practice." I took an (overpriced) course at the Purple Valley Yoga Center with one of the foremost experts in Ashtanga. Nancy Gilhoff began practicing Ashtanga Yoga over 30 years with K.Pattabhi Jois in Mysore, India. As a result of her close association with Pattabhi Jois, Nancy is able to teach with the style and touch that was transmitted directly from "Guruji." Nancy is also a student of Baba Hari Das and various Iyengar teachers. She is the director of the House of Yoga and Zen on Maui. She travels to Europe doing workshops in various locations and around the US with the intention of sharing her experience of yoga with others. Her studies have led her to the dharma teachings of the Dalai Lama and the expression of love and compassion for all beings.
After more than 30 years of Ashtanga practise, Nancy is more convinced than ever that this style of yoga as taught to her by Sri K.Pattabhi Jois works best when it is followed strictly to the original form and she continues to teach as he taught her. During my yoga course, we closely followed the "Mysore" tradition. Mysore class is a traditional format for teaching. Mysore is a town in South India where Ashtanga Yoga is taught. In this class the teacher works with each person individually and everyone is allowed to do their own individual practice. This approach teaches students to memorize the sequences very quickly. Also there is no need to try to keep up with the class. It may sound a little daunting to beginners, but this is actually a very comfortable way to learn. You will receive a lot of individual attention at first and then you can look at diagrams and practice the postures carefully under the watchful eye of an experienced teacher. For those who already know the sequences these classes offer a great freedom to move at your own pace.
For the most part, I practiced the Primary Series of Ashtanga Yoga. Primary is a hot, sweaty class. Here you begin to breath with great precision and learn to practice without missing a single breath. Aspects of strength, endurance, concentration and deep structural alignment are introduced. This is the classical primary sequence taught in many places around the world. During my course, Nancy had some classes/ discussions on practice utilizing the breath, use of bandhas, and the intention of the practioner. We also learned about ways to prevent injury during practise, the loving kindness meditation, breathing practise and examining the role of intention as a spiritual tool.
Sunday, February 4, 2007
This article does a really great job at summing up another approach to Yoga. The Ashtanga yoga experience is QUITE different from the Sivananda experience.
My final week here in India is in Goa at the Purple Valley Yoga Center. More details to come soon, but definitely read this article!:
Thursday, January 25, 2007
My trip to India could not feel complete without a short tour of North India. We visited Agra to see one of the seven wonders of the world, the Taj Mahal. The Taj Mahal is one of the world's most famous buildings. It was built by the Mughal emporer Sha Jahan in memory of his favorite wife, Mumtaz Mahal, who died in 1631 during childbirth. It's perfect proportions and exquisite craftsmanship have been described as "a vision, a dream, a poem, a wonder." The sublime garden-tomb, an image of the Islamic garden of paradise, cost nearly 41 million rupees and 500- kilos of gold. About 20,000 workers laboured for 12 years to complete it in 1643. There are 4 minarets, each 40 meters high and crowned by an open octoganal pavilion or chhatri at each corner of the complex. These frame the tomb, highlighting its perfect symmetry. There are calligraphic panels that decorate the Taj. The size of the Koranic verses built along the panels increases as the arch gets higher, creating the subtle optical illusion of a uniformly flowing script.
It is widely believed that the Taj Mahal was designed to represent an earthly replica of one of the houses of paradise. Its impeccable marble facing, embellished by a remarkable use of exquisite surface design, is a showcase for the refined aesthetic that reached its height during Shah Jahan's reign. Described as one of the "most elegant and harmonious buildings in the world," the Taj indeed manifests the wealth and luxury of Mughal art as seen in architecture and garden design, painting, jewellery, calligraphy, textiles, carpet-weaving, and furniture. The Mughals were great naturalists and believed that flowers were the symbols of "the divine realm." In the Taj, pietra dura (inlaid marble design) has been extensively used to translate naturalistic forms into decorative patterns that complement the majesty of its architecture. The Florentine technique of Pietra Dura is said to have been imported by Emporer Jahangir and developed in Agra as "pachikari." Mionute slivers of precious and smiprecious stones, such as camelian, lapis, lazuli, turquoise and malachite, were arranged in complex stylized floral designs set into a marble base. Flowers, such as the tulip, lily, and narcissus were depicted as sprays or in arabesque patterns. Stones of varying degrees of color were used to created the shaded effects. Even today, artisans in the old city maintain parttern books with the fine motifs used on the Taj to recreate 17th century designs in contemporary pieces. Close to the Taj, vendors will flood you with offerings to purchase replicas of these designs in the form of coasters, boxes, and any marble tchotchkie you can think of!
Other artistic elements in the Taj include the carved relief work, the calligraphy, the floral sprays, and the Jali patterns, which are on the octagonal perforated screen surrounding the tombs. They are a complex combination of the geometric and floral. The filtered light captures the intricate designs and casts mosaic-like shadows on the tombs.
We saw the Taj Mahal at sunrise. We woke up in the dark and watched patiently as the light emerged and bathed the Taj. What an incredible sight! I took a ton of pictures. And of course, there could have been many, many more. It is truly a wonder. And to imagine that the Mughal (ruler) built it for his wife. This was definitely a labor of love!
Wednesday, January 24, 2007
In order to get a true perspective on all aspects of medicine in India, I decided to spend a few days at an Ashram. The Sivananda Yoga Vedanta Dhanwanthari Ashram was established in 1977. It is dedicated to the practice and dissemination of the "Synthesis of yoga."
Yoga (Devanagari: योग) is one of the six schools of Hindu philosophy, focusing on meditation. In India, Yoga is seen as a means to both physiological and spiritual mastery. Outside India, Yoga has become primarily associated with the practice of asanas (postures) of Hatha Yoga (see Yoga as exercise). Yoga used as a form of alternative medicine is a combination of breathing exercises, physical postures, and meditation, practiced for over 5,000 years. 
Yoga as a means of spiritual attainment is central to Hinduism (including Vedanta), Buddhism and Jainism and has influenced other religious and spiritual practices throughout the world.  Hindu texts establishing the basis for yoga include the Upanishads, the Bhagavad Gita, the Yoga Sutras of Patanjali, the Hatha Yoga Pradipika and many others.
The four main paths of Yoga are Karma Yoga, Jnana Yoga, Bhakti Yoga and Raja Yoga. A committed practitioner of yoga is referred to as a yogi, yogin (masculine), or yogini (feminine).
From a medical perspective, I was interested in the healing aspects of yoga, as well as the refining of my own athletic and physical potential. For some, Yoga used as a form of alternative medicine and is a combination of breathing exercises, physical postures, and meditation, practiced for over 5,000 years. 
A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this survey, Yoga was the 5th most commonly used CAM therapy (2.8%) in the United States during 2002.  Yoga is considered a mind-body intervention that is used to reduce the health effects of generalized stress.
Yoga is believed to calm the nervous system and balance the body, mind, and spirit. It is thought by its practitioners to prevent specific diseases and maladies by keeping the energy meridians open and life energy (Prana) flowing.  Yoga is usually performed in classes, sessions are conducted at least once a week and for approximately 45 minutes. Yoga has been used to lower blood pressure, reduce stress, and improve coordination, flexibility, concentration, sleep, and digestion. It has also been used as supplementary therapy for such diverse conditions as cancer, diabetes, asthma, AIDS and Irritable Bowel Syndrome.
After a few days at the Ashram, I felt like I had officially become part of the Indian Yogi experience. The Sivananda Ashram is the place where many people go to discover the origins of Yoga and learn from people who have been taught by the original masters! The Sivananda Yoga Ashram was created as an abode of peace to "serve as a place of shelter from the pressures of daily life." They aim to "provide a conducive environment for self transformation and the pursuit of spiritual ideals." The majority of people there were attending a month-long Yoga teacher's training camp. It truly felt like camp. At first, it felt a bit cult-ish. And there are parts that would continue to strike many people as such. We attended the "yoga vacation." This focused on utilizing a strict schedule that was based on teaching the 5 principles of Yoga (as taught by the Guru's, Sri Swami Sivananda and Swami Vishnu-devanandaji).
The 5 principles of yoga include:
Proper Exercise [Asanas]
Proper Breathing [Pranayama]
Proper Relaxation [Savasana]
Proper Diet [Vegetarian]
Positive Thinking & Meditation [Vedanta & Dhyana]
The strict schedule was as follows:
6.00hrs Satsang (group meditation, chanting and talk)
7.30hrs Tea time
8.00hrs Asana class (breathing exercises, postures and relaxation;separate classes for
beginners and advanced)
10.00hrs Vegetarian meal (moderately spiced)
11.00hrs Lecture (talk on various aspects of yoga)
12.30hrs Karma Yoga (selfless service)Karma Yoga, selfless service, is an essential part of
yoga practice. The Ashram is run mainly by selfless volunteers and the guests are
requested to do some service by helping out wherever it is needed.
13.30hrs Tea time
14.00hrs Coaching Class (optional)
16.00hrs Asana class
18.00hrs Vegetarian meal
20.00hrs Satsang (group meditation, chanting and talk)
22.30hrs Lights out
What a schedule! There are pages and pages of books and websites to explain the details, for those who are interested. I was literally exhausted by the end of the first day. I averaged about 4 hours of yoga a day, complete with a half hour of "breathing exercises" at the beginning of each class. I am not a huge fan of the rhythmic breathing exercises (Pranayama), but I tried. Peole frmo from all over the world attend the Ashram: Israel, Germany, France, UK, USA, Canada, India. Everyone had their Yogi uniform on-- white pants, an ashram-themed t-shirt. The requirement was loose-fitting clothing. Now, we Americans prefer our tank tops and black yoga pants. But, no shoulders or bare bellies! So I soaked my way through some cotton pants and t-shirts, slipping all over the yoga mat, but feeling rejuvinated by the end.
I loved all the yoga, but the parts that took some getting used to included: 2 hours of chanting and meditating; the uniforms; the "silence during meals;" eating on the floor cross-legged, using your hands; rhythmic breathing til you see the yoga gods because there is not enough oxygen in your brain... Not that I'm being critical. I was just very entertained. I did get into the spirit of it all, though. It's pretty hard not to. By the end of three days I, too, was clapping my hands to the 'hare krishna' song. I learned that Om Shanti means "Om" Peace. And I realized that many of the thoughts behind the program are for your own personal spiritual enlightenment and awakening. I am pretty psyched that I can now get up in "headstand" and can hold myself in a pretty sweet "crow pose." My body feels stronger, and my ability to sit still with my own thoughts has definitely improved. And, from a medical perspective, I was able to appreciate a totally different approach to healing. I think yoga is fabulous. And a strict vegi diet felt very "Clean."
The ashram was quite an experience! If you're at all curious about the swami's or the gurus, you can check out the website. They have programs and ashrams all over the world! Even in California and NY. http://www.sivananda.org/neyyardam/index.html
Monday, January 15, 2007
Twice a month, two nurses will go to a cluster of villages where they have been assigned. They will visit the village the week before the doctors go in their Mobile van, and then will follow up the week after the Mobile MD clinic. Most of these visits occur in people's homes. And the majority of these home visits are for prenatal and antenatal care. There are also some visits with high risk OB patients and chronically ill patients who have diabetes and hypertension. Nurses will do standard prenatal visits where they will measure fundal height, check fetal heart tones, and check the woman's blood pressure. They will also do blood pressure checks for the hypertensive patients and deliver appropriate medicines to those who need it. The structure of the visits is effective because they can decide whether a patient needs an appointment with the mobile MD clinic, or if something is serious enough to warrant a visit to the main hospital in Vellore.
The nurses each have a full registry of all pregnant women in the area. Every woman is registered within 3 months of becoming pregnant (if she realizes she is pregnant) and will then receive the appropriate prenatal care. Impressive! Each nurse is responsible for about 7,000 patients.
The day was very interesting. It was exciting to see people in their home environments, going about their routines, participating in village life. Generally, everyone takes off their shoes before entering the home. I appreciate this because I was raised in a "shoes off" house. Although, I had to laugh because sometimes there is more dust and dirt inside the house than outside. The intention is admirable.
One woman we visited needed to have her stitches removed from a tubal ligation. I think I have already mentioned how the government provides financial incentive for sterilization. Population control is definitely in effect here! I had the opportunity to help with some prenatal exams and listen to fetal heart tones. Here, we used a stethoscope to listen to fetal heart tones. I was surprised I could hear them. We get so used to using the doppler in clinic, it is easy to forget the subtleties and graces of the simple approach to physical exams!
As an aside, today was Pongol, the harvest celebration in Tamil Nadu. In celebration of the holiday, many of the families we visited offered sweets and food. I have become wary of tasting local food after a few too many days with a GI problem. So, I kindly accepted my edible treat, and "saved it" for later. One household showered us with flowers in our hair. They are deliciously fragrant white flowers, tied together on a string. It is nice to get a whiff of the flowers after a long, sweaty day in the village!
Sunday, January 14, 2007
Well, I have officially experienced the most relaxing place of my trip. Pondicherry was colonized by the French and has now been left with a distinct flavor (architecture, language, food, wine). It is also has one of India's most famous Ashrams (or meditation centers). The Sri Aurobando Ashram has 5 guest houses affiliated with it where you can stay for a very cheap price as long as you follow the rules: no alcohol, respect the quiet meditation areas, strict curfew of 10:30pm...
Sarah & I travelled here with 3 other students from San Antonio. We shared a very comfortable car ride and arrived here friday evening. The roads are not nearly as sketchy as I had heard. In fact, I was pretty impressed with the quality of the highways and roads even in the smaller towns. Well, we totally lucked out and got the most sought after guest house and even managed to get a room with an ocean view! The Park guest house has a huge garden for morning yoga or meditation. We sleep with mosquito nets since we're near the sea-- but it makes it seem like an adventure. It is like a big dorm room with 4 beds and a big balcony.
The food is great! Tonight, sarah & I are looking forward to a glass of french wine :) I spent the day on a much needed relaxed schedule, doing some sun salutations on the grass to start my day. They were actual sun salutations, since we are facing east and are literally right next to the ocean! I then headed out for a short run along the waterfront. There's something about beach towns. Even some of the locals here were out walking and jogging in the morning. Our breakfast was fresh and yummy. But our next stop was when the adventure began.
The Prana ayurvedic and yoga center is a hole in the wall run by a little Indian guru. He led the 4 of us in a 1 hour Hatha yoga class. Breathing, stretching, and even a little rough pushing to get my tight muscles into some crazy positions! Sarah & I stuck around to experience Ayurvedic massage. The woman who did my massage did not seem to beat the crap out of me in the same way that Sarah's guy did. But there was LOTS of oil and ultimately some very loosened muscles! It was not remotely what I expected, but I was VERY relaxed afterwards.
I'm going to end here and finish up my Pondicherry summary later. We're going to head to a highly recommended French restaurant called Rendezvous to enjoy a little French wine...
So, more updates soon. Just wanted to let everyone know that I managed to escape the overcrowded city in exchange for a peaceful traveller's wonderland. Definitely lots of travellers here! Heading back to Vellore tomorrow, wishing I could stay here longer!
Saturday, January 13, 2007
One wonderful aspect of the Vellore health system is the community based health care. The delivery of health services in this part of India is better than many places in the U.S! It is certainly a progressive concept to bring health care TO the community. I know the incredible number of hurdles patients in San Antonio have to experience just to get to an appointment, no less access the health system in general.
Today we joined the 'mobile clinic' with the doctors. None of the villagers speak English (they speak Hindu, Tamil, or something else I don't understand). So, even with all the observing, I was even more distanced from the experience because I could not understand a thing. I listened to a few heart murmurs here and there but mostly enjoyed seeing village life. There are a significant number of patients with Rheumatic heart disease. Other diseases I have seen on doctor's rounds include congenital heart disease (ventricular septal defect, Truncus arteriosis), Diabetes, Hypertension, seizure disorder, to name a few!
In Vellore, there are multiple levels of health care delivery for pretty much every health care need (save for the super complicated health issues that need expensive surgical intervention). The mobile clinic takes the Doctors to the community once per month. Each doctor is assigned to a specific community and basically covers a population of 120,000 per doctor. The nurses visit the villages twice a month-- once on the week before the doctors arrive so they can make appropriate appointments and once the week after the doctors to provide follow up and deliver any medications, do blood pressure checks, etc. Patients are charged on a sliding scale, based on level of income, and will receive medications, routine exams, chronic care, and hold on to their own health care record. They have continuous prenatal care beginning at 3 mos and have well-baby checks as well.
The doctor on duty was the Community Health resident (think Family medicine), whom they refer to as the "Registrar" here. He was accompanied by an intern, who is actually pursuing a residency in anesthesia. The "PICHU" (part time community health worker) is basically the locally based health care provider who serves as the midwife. She knows all the details about each family's health and socioeconomic status. She helps determine the sliding scale fee for service.
The mobile pharmacy is stocked with a significant number of medications including chlorquin, Digoxin, Carbamazapine, Cipro. This country (or at least this region) appears to have a pretty sophisticated health care system even at the rural level. The resident did, however, state that these villages are significantly more developed than actual 'rural' communities. Here, they are also able to track the population statistics really well because of the medical college. In all of Vellore, they have every person, death, birth, totally accounted for. It seems like the epidemiologist's dream!
Everyone is so friendly here! The kids LOVE having their pictures taken. The children are certainly a highlight of the village experience. And digital cameras make it even better because the kids just jump up and down at the idea of seeing themselves on camera! Every village is also incredibly colorful. Almost all the women wear colorful Saris. Each one unique and beautiful. Even the women in the villages wear intricate designs. Some of the saris are obviously not as nice as the people who are wealth would wear, but the colors are still amazing.
As an aside, Sarah & I noticed how many of the people have really great teeth here. Not sure if it's genetics or some tradition. They use a particular plant to brush their teeth with-- it's called Neem. Surprisngly, I really have not seen the type of tooth decay one would expect in poor communities. Interesting!
As for my own personal health, I have officially limited my intake of spicy Indian food to once a day. You can't totally avoid a few flavors here and there (which is nice) but the whole all-Indian all the time was doing a number on my tummy. Ow! The breakfast at the hotel is great-- for just over a dollar I get coffee (with thick milk already in there), an egg white (made to order) , toast (only white bread here), fruit, and juice (frothy goodness in a little glass). I could drink the juices here all day. They are so tasty! But lucky for me, they limit my intake to a little 5 oz glass of sweet delight. We had to pack lunch to go out to the community today (tomorrow too). But the portable lunch options only come in the form of indian food. And since you eat with your hands here (right hand only) and since I didn't want to risk the results of the spices in a village, we stuck to fruit and biscuits. Luckily, Sarah brought some protein bars that we could supplement things with. But that supply is limited. We have tried like really hard to find some peanut butter to supplement our lunches. I am not sure that exists here! When we ask for PB, we get lots of blank stares and people trying to sell us regular butter instead.
Tomorrow we'll head out to the community with the nurses. Should be more interesting because they do door-to-door in home visits. It is challenging to spend most of the day "shadowing" since I had so many opportunities more recently to do "hands on" clinical work. It is also challenging to be limited by a language barrier. I appreciate seeing how well the mobile clinic operates and getting some first hand insight into the structure of the health system in Vellore. I am continually impressed by this system!