The Taj Mahal

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!

The Sivananda Yoga Ashram

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. [1][2][3]
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. [4] 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. [1][2][3]

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.[4] According to this survey, Yoga was the 5th most commonly used CAM therapy (2.8%) in the United States during 2002. [5] 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. [6][7] 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[8] and Irritable Bowel Syndrome.[9]

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:
5.30hrs Wake-up
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

Nurse's Rounds

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!

Weekend Getaway to Pondicherry

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!

Vellore, CMC Doctor's Rounds

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!

The Winter Symposium on Diabetes and Endocrinology

I had a special learning opportunity for the past few days. There is a Winter Symposium here at the medical college on Diabetes and Endocrinology. Specialists from all over the world are here to speak, discuss, and attend sessions on clinical cases and new data.

Today, I attended a case conference. Dr. George Koshy, a faculty member here at CMC presented an interesting case. The title, "A Trilogy." For those of you interested in a little clinical medicine, the case is as follows:

A 17 year old male from West Bengal presented with progressive weight gain, erectile dysfunction, and painless, progressive gynecomastia. He had a BMI of 30, Tanner stage 3 gynecomastia, with a normal thyroid and normal CNS exam.

Labs:
nl LFTs
nl FSH
nl TSH
significantly increased PRL

The differential diagnosis included Pubertal Gynecomastia, surreptitious use of drugs, endocrine dysfunction.

Imaging:
microadenoma seen on MRI, measuring 9x9 mm

The treatment options included medical management vs. surgery. They opted for surgical intervention of the microadenoma. The patient also had plastic surgery for his gynecomastia. After surgery, the patient's PRL normalized.

The story continues...

3 years later, the patient returned for follow up with hypercalcemia, increased Alk. Phos, decreased Phosphate, and significantly increased PTH. He was subsequently diagnosed with hyperparathyroidism and found to have MEN I. The doctors decided to check his serum gastrin and found he had a gastrinomia. A textbook case, for sure!

In 2005, the patient presented with severe nausea and vomiting and was found to have multiple duodenal tumors (gastrinoma).

They gave some statistics about MEN I in India:
prevalence 1/30,000
95% present with parathyroid adenoma
25% with prolactinoma
40% with gastrinoma
85% with angiofibromas

Thoughts...

I really enjoyed attending the symposium and getting a broader look at health in India in general. It is an awesome experience to see the research that is occurring here and the multilayered approach to clinical care and clinical research. I get very excited by conferences and academics-- helpful reassurance for career choices. I was very stimulated by the issues presented at the conference.

Each day is structured by topic: Thyroid, Pituitary, and finally, Diabetes. In India, there are 32 million people with Diabetes. It is not too hard to understand why. The bulk of the diet is based on carbohydrates. I read that on average, each Indian consumes 2kg of rice PER DAY!!! And, based on my observations during meals, I would agree.

The food is very tasty. However, my approach has been very backwards. We tend to order what is more commonly known as "sauces." I consider these (ie. chicken tikka masala, paneer masala, dal) the main course. This is probably why the spices really get me! In actuality, you are supposed to fill your plate with rice, and use these "sauces" to flavor the rice. No wonder people eat so much rice! Not to mention the chapati, naan, dosa.... I'm not a huge fan of rice. But people manage to fill there plate and mix around the lovely selection of flavors while gracefully placing it in their mouth with their hand (right hand only). I'm not such a fan of the hand-eating. It's a mess. And the texture of the food in my hand is something to get used to!

CHAD (Community Health and Development)

CHAD is our equivalent of Family medicine. It is a multifaceted approach to community medicine that is broad spectrum and community based. It is also integrates a Public health approach to medicine that includes community health education, disease prevention, and many social aspects of health.

I attended CHAD ward rounds. This community hospital is a secondary health care facility where the residents are trained to care from people from birth to death. It is a practical approach to community health, especially in an 'international health' environment. By that, I mean that there is a clear integration of maternal & child health. Women are mostly accessing the health system in regards to reproductive issues and women's health is primarily a function of obstetric care.

The family outreach center has social workers who work with community members on developing health relationships, creating culturally appropriate approaches to health care, and provide community health education. There was a poster on "How to have a health marriage" and another poster depicting X & Y chromosomes with the message about how it is the Male who determines a baby's gender. This is clearly an effort to curb female infanticide and perhaps alter the family dynamics when gender becomes an issue.

Within CHAD, there are opportunities for people in the community to work. Community members can contribute by sewing gowns for the hospital, doing manual labor to build new structures, and help distribute supplies throughout the system. It is interesting to see little old ladies in their saris carrying bricks and digging holes!

I find myself very drawn to the women and children. In this environment (and in many environments) it definitely makes sense to have the continuity of care where women can come for health care and have their children receive health care as well.

Vellore, Christian Medical College History

We spent the majority of our first day at the Christian Medical College (CMC) getting our schedules and making contacts for our first rotation, the Community Health rotation (C.H.A.D-- community health & development). The director gave us this really fascinating personal lecture about the CMC and how it was all started.

Ida Scudder was founder of CMC and the daughter of a missionary physician. She decided to leave India when she was 18 because she 'hated it' and had no interest in following her father's footsteps. She did not want to stay in India and she certainly was not interested in practicing medicine. Years later, Ida Scudder returned to India because her mother had fallen ill. She had been studying English Literature but returned to India because of her mother. During the time Ida Scudder was back in India, she had a unique experience one late night.

There were three separate incidents of men who came to the door pleading for help. Each man was the husband of a woman who was in labor and desparately needed a female physician's help. Each time a man came to the door begging for help, Ida Scudder stated that she could not help and had nothing to offer. The next morning, she awoke to the sound of drums. This could only mean one of three things: a wedding, a birth, or a death. Unfortunately, the drums were the sound of death. All three women had died during childbirth.

Ida Scudder then realized that she was unable to help these women and ultimately, prevent their deaths. it was at that moment, that Ida Scudder realized she had a calling. She started the CMC as an ALL women's medical school. It remained an institution for only women until 1950. Very inspirational! And very cool. When she first decided to become a medical provider in India, Ida Scudder had decided that she did not want to build a standard hospital. She figured that anyone who would go to a hospital 1) knew they were sick 2) knew where to get help 3) could afford to get help. The people she wanted to heal didn't have any of those things. Instead, the underserved communities she wanted to help 1) Did not know if they were sick 2) would not where to go 3) could not afford the health care they needed. She truly wanted to provide for the underserved and created the CMC as a vehicle to do so.

The educational structure that was created focused on community health education. All students were required to learn about health in the community. However, the medical students protested the idea of classroom learning and decided that they wanted to learn about community health IN the communities. The students created a rural health clinic so they could learn about community health up close. And later, the communities demanded that healthcare be provided in the process. This was definitely the beginnings of a student-run clinic! Now, there are clinics in every local community in Vellore! To this day, students continue to get training in community health, epidemiology, and public health.

There is a detailed structure of community health providers. More on this later. In general, there is a health worker who lives in the community, 3 nurses for every 15,000 people, and 3 doctors for every 45,000 patients. There are health aids, home nursing visits, and mobile doctor clinics.

The CMC is the most prestigious medical school in India. They accept 60 students per year. They have tertiary care facilities, imaging, lab tests, modern day everything all the way down to the community level with mobile clinics and home visits by nurses and physicians who go into the villages to provide health care. It is a really impressive health system. They also do an amazing job of utilizing epidemiology & statistical methods to track people & diseases, and provide a truly community-based health effort.

Part Time Community Health Workers (PICHW)

The "Peetchu" has existed in the villages of Vellore for many, many years. She used to be the primary (and only) health care provider and midwife in the village. Traditionally, she was the barber's wife and would pass her skills onto her daughter in law. She is in charge of 70% of deliveries. However, the government is trying to pass a law that all births are to be done in a hospital because of concerns over HIV transmission, early detection of HIV, and female infanticide.

Now the PICHU primarily cares for chronically ill patients. There are 69 villages in Vellore, each with their own PICHU. They help keep statistics on community health, birth and death statistics. In addition, each community gets its own health aid to help with record keeping and health education. As a result, the CMC has created a degree program (masters) for doctors interested in community health.

The nurses are identified by their Sari colors. The nurse wears a light blue sari. Each nurse is in charge of 15,000 patients. The health aids wear a pink sari.

An interesting piece of history...

When the director of the CHAD was explaining the structure of the PICHW system to us, he described things before the system was created. Later, in reading a very interesting book by a former New York Times correspondent, I learned that there were some widespread health practices that later became incentive for the government to intervene in the system. Prior to PICHUs, there was a village dais, or midwife. Her position was ultimately abolished because the traditional practices helped keep India's maternal mortality one of the highest in the world. Some of the dangerous practices include pushing on a mother's stomach during labor, risking uterine rupture, and cutting the umbilical cord with an unsterile knife or a stone. On the wound, they would put cow dung, which they believed was antiseptic. Now, I know that India is definitely not the only place where some traditional practices clash with the preservation of 'clean' and safe health practices. But it was certainly interesting to read about something I just heard about from the CHAD guy!

In case you are interested, the book is called "May you be the mother of a hundred sons," by Elizabeth Bumiller. It's a really fabulous account of women and Indian culture.

Arrival in Chennai, India

After about 30 hours of travel, my friend Sarah and I finally arrived in Chennai. We are staying at the Breeze hotel for the weekend until we head out to Vellore, where we will attend the Christian Medical College, mostly as 'observers.' I'm sure there will be so much to report about that once we get to Vellore.

Today was our first 'official' day in India. Today's goal: find a market area. It was actually for practical purposes. My bag was checked and never made it here-- I guess it got stuck in Houston. It is supposedly on its way and should arrive sometime before we head to Vellore on Sunday. Today, I had to make it my goal to find an additional shirt to add to the clothes on my back. Sarah & I headed into the city by way of Auto-rickshaw. These funny little yellow vehicles resemble a turtle on wheels. The yellow shell sits atop a single front wheel with two back wheels under the passenger bench. We sat comfortably in the passenger's bench as the rickshaw weaved its way through the busy streets of Chennai. Traffic here is like a dance. Everyone knows who has the right of way and very few people seem to get confused by the process. Other than the tourists, of course! We managed to arrive at our destination, even though our driver was convinced we should hire him for the day as our personal tour guide. Maybe tomorrow. Not ten minutes after our arrival, we had new tops. I think it will be impossible not to stand out here. Yes, I am now the proud owner of a purple tunic-dress. But I don't think the most elaborate sari would cover up how white and different I look from everyone here. The streets are teeming with people. There are a significant amount of street people and beggars. Most women wear beautiful saris. I did not realize how inexpensive the saris can be! And I had no idea how elaborate the process of wearing the Sari is! They range from $3 to 50+ and come as a 5 yard piece of material. There is a whole process of wrapping and tucking and draping. You can also choose fabric and have them make you an outfit. Crazy.

After the bustle of downtown, we decided to head to a more serene environment. We headed to the Theosophical society, located in a far more suburban neighborhood. There's a whole school of thought based on the idea of peace and tolerance amongst all people of all colors, creeds, religions, and backgrounds. I bought a couple of small books in the bookshop by some of their prominent thinkers. We walked on the campus and through the gardens. The main attraction is the gigantic Banyan tree-- supposedly the biggest in the world. It was nice to let my guard down for a stroll through the gardens after a crazy morning in the city center. We wrapped up day 1 of our Chennai tour at the beach. I would definitely call the Marina beach a 'city' beach. There were all types of people-- fishermen in colorful boats and handmade rafts, families, kids playing in the water, vendors, and schoolchildren. The sand has plenty of trash on it and the fisherman line up their sardines along the sand. The body of water is the Bay of Bengal. I dipped my toes in-- pretty warm! I think the highlight was during our walk through a memorial garden. Sarah and I were fascinated by a large group of people-- young and old-- dressed in red. They were a school group from Bangalore (a neighboring city) all dressed alike. Women and girls in red saris with yellow trim. Men in red shirts and red "manskirts" aka 'Lungis.' The colors were amazing. Well, just as we were enamored with them, the group was actually enamored with us. It turned into a big picture taking fest.

Digital photos are such a great way to communicate! We took pictures and showed the group. The next thing we knew, everyone was shaking our hands, saying thank you, asking us our names, giving us hugs, touching our skin. What an experience! Now I'm back in the hotel. My energy is waning quickly. My body is definitely confused. My fatigue has been outweighed by the excitement of a new place. So many sights, sounds, smells (!). I have eaten yummy food and so far, so good. South India has many vegetarians so there's a lot of creative uses of vegetables, cottage cheese (aka Paneer), tofu, and chickpeas. The dishes here are amazing! I don't know how I'll do with these flavors every day. But for now, its novel and delicious!