India Part Four: Monsoons, the operating room, Jackie Chan, white-face mime acts, giant moths, and more cows.

I must first apologize for my delay in updating... I am sorry to say that my trusty camera that has served me so well for the past 5 years has met with an untimely end. I think the journey here was just too much for it. But I have ordered a new camera from Amazon India, and all shall soon be right with the world once again! 

It's been a busy couple of weeks! My project is off to a solid start, and I think i'm adjusting pretty well to life here! 

There are a few things I still find difficult however... For instance, I am used to being able to get pretty much anything I want in America from my local everything corner store, but its nothing like that here. I wanted to get some more hangers for my clothes; that was a fun one to try to mime with the front desk clerk, and totally unsuccessful I might add. The misunderstandings are numerous and amusing, you think you have been clear and the person you're talking to understands what you're asking, but then you end up with something completely different . After dinner the other night, I ordered a coffee AND a bowl of butterscotch ice cream. What I received was a scoop of butterscotch ice cream in my coffee.

LONG LASTING WHITENESS! (With whiteness boosters!)

How can a tomato be naughty? Do I really want to know?

Banana cart

looks safe...

I can’t get any American TV online here (except Comedy Central) so nobody better tell me what happened on Project Runway this season! I have a television in my room, but there are only 3 channels in English here, and they play movies round the clock... I like to have background noise while i'm working, so I end up watching a lot of movies. Step Up 3, Madagascar 3, every James Bond, and National Treasure 1, 2, 3, 26, and so on are played repeatedly. Oddly enough Kung Fu Movies (especially ones featuring Jackie Chan) are the obvious favorite in India. There's even a nightly block of them weeknights on one of the channels. 

One thing I am not adjusted to here is the way things just stop working. Electricity, television, internet, elevators, you name it. Always without warning, and always at the least convenient times, the other night the new batman movie was on, the Dark Knight Rises (Spoiler alert- kind of). I hadn't seen it, and I was getting pretty into it. Then, right at the end, as the villainess reveals that the nuclear bomb can’t be disarmed and all seems to be lost for the city, Batman attaches the thing (set to blow in 30 seconds) to his bat-motorcycle/plane/all-terrain vehicle, and flies out over the ocean and away from the city, and then………… my TV went out. Does he live? Does he save the city? Does the impact of the bomb over the ocean cause a massive tsunami that destroys the city not to mention all sea life within hundreds of miles?!? I’ll never know, at least until there’s another rerun that is.

So what is daily life like? (Other than hot and humid). 

• Well I wake up around 6:30, get ready, and then head down to breakfast. There is always porridge and “toast” (basically just sliced white bread they spread jelly and butter on), as well as some kind of traditional south Indian breakfast dish. Then I head to work around 8:00, no later than 8:30 though because after that there will be too many computers on the system and I won’t be able to log on to the internet.

My office- OSU Represent! 

The main hospital

The building I work in

• A housekeeping sister brings me coffee in a little teacup around 10:00 and then sometimes a bottle of water around 10:30

• I work until 1:00, and then head back to the guesthouse for lunch, (it’s rice)
• Then I go back to my office and work until 4:00 or so, Right now I am meeting with the different heads of departments and senior doctors to discuss their department in relation to my project (tracking patient compliance). I am trying to identify at which points in the treatment process (starting with the patient seeking care, all the way through to follow up) patient compliance is an issue. For example, in the Cataract department, I am focusing largely on the point where the patient accepts the surgery advice, then when the patient needs to engage in self-care following surgery (taking antibiotics, using good hygiene, etc.), and finally when the patient must return to the hospital for a post operation checkup. Identifying these points is only the first step, next I begin looking at ways we can investigate WHY patients are non-complaint at these points. But more about that later on in the process.
• After work I head back to the guest house, sometimes I go to the market or something if there is someone else who wants to go with me. The rule here is girls are not supposed to be out alone after about 8:00. It's a really safe city and i've been told that women are much stronger and more empowered here than in other places in India, but you can never be too safe and its not worth taking chances. To be honest navigating through traffic is so overwhelming I wouldn't want to go anywhere by myself anyway haha

The entrance to the Pudamundipum market

Street scene near my office

One of the temples, its about 4,000 years old!

• Dinner is from 7:00-8:00 (more rice)
• Then I usually take a shower (its always cold and I have to imagine I am jumping into a lake or something) and then I read before bed. 

It's crazy how much I have become adjusted to life here in just a short time already. The heat/humidity hasn't been bothering me AS much, and I just assumed it's been cooler or something since we are headed into fall. Wrong, I checked the weather yesterday, 92 degrees and 71% humidity. 

Things that would have stopped me in my tracks a few weeks ago seem almost normal now. For instance, I was talking with a girl named Stephanie at dinner the other night who is here from the University of Pennsylvania working, we were discussing how difficult crossing the street is here. She was telling me a story about how she was trying to cross the street the other day, but anytime there was a slight lull in the traffic flow, a motorcycle would come screaming by. She was growing more and more irate, and she began to get really frustrated, sighing heavily and muttering angrily to herself, like you would if you were stuck in traffic. But apparently no one does that sort of thing here, because a very tiny elderly woman reached out, patted her on the arm, and then tugged Stephanie out into the road with her and proceeded to help her navigate through the traffic, across to the other side of the road. Stephanie was caught off guard, and very much wanted to thank the woman once they reached the other side, but the old woman was walking next to her staring resolutely ahead. At this point in the story, you have to imagine Stephanie describing to me her futile attempts to get this woman’s attention “So we are just walking next to each other, and I just keep staring at her and smiling like a crazy person, hoping that she will glance over, but she doesn't, she just keeps walking and staring ahead… finally we had to part ways at a goat standing on the sidewalk.” At this point I had to stop her and clarify “You… parted ways… at a GOAT?” and she replied “Yes, we could not keep walking next to one another because there was a goat on the sidewalk, so I stepped off the sidewalk and into the street”. Like it was the most normal thing that could happen to a person, a goat taking over a city sidewalk. That’s how it is here, at first you’re like “OH MY GOD that cow is standing in a pile of trash eating a candy wrapper!!!” and you feel more than mildly disturbed and a little conflicted; do you try to intervene and stop the cow from eating it? Do you stop to take a picture? What is the appropriate action here? But eventually it just becomes, “Oh…that cow is eating a candy wrapper” or “Yes, I had to step off of the sidewalk into the road because a goat was standing on it”. And that’s just life here.

That's a cow outside my building

There is a man who sells used shoes, that’s right used shoes, from a blanket under a tall bush. He spreads out his blanket every day in the same spot and lines up about 10 pairs of shoes of various sizes and styles in a semi-circle in front of him, and there he sits. At night, he puts away his shoes, curls up under his display blanket, and sleeps right there in his office. 

Another example, there is a very elderly man who sits on the sidewalk across the street from the building I work in, not every day, but a few times a week without fail. And as I pass him on the opposite side of the street, he yells out some sort of greeting and waves frantically to me. I have never met this man. Nor have I even been on the same side of the street as him, but he still shouts his greeting to me like I were an old acquaintance he hadn't seen in years. I wave back, and he is satisfied.

 One of the doctors visiting here, Dr. Miller from Arizona, has told us about how, when he goes out for his morning run, curious people will literally jog alongside him to ask where he is from, what he's is doing in Madurai, and does he like India? All the usual questions.

This dog is always around my office building ,  I say hello to her as I pass and she wags her tail a little and then goes back to her nap in the shade

View from a rickshaw- those round piles of what appear to be trash are actually makeshift huts, pieced together from paper, fabric and what appears to be trash.

roadside temple- these are all over the place, each one dedicated to a different deity I think

Lions represent strength, protection and prosperity. Here a lion statue is worshiped in a roadside temple

The "Event"

On Sunday we wanted to visit the Gandhi museum, unfortunately the curators decided that they wanted to go home early that day or something, and it was closed. So as we were walking back to the guest house, we heard loud music and singing coming from inside a gated park. How could we not check it out? As we approached the large open pavilion that was the source of the music, we were handed a program (written in Tamil) and saw that that hundreds of chairs had been set up in front of a large stage. We had but a moment to ponder whether we should sit down in the back and see what this event was all about, before a woman dressed in a white sari motioned to us to follow her, and led us from the back of the giant hall, past hundreds of rows of chairs, all the way to the front, and indicated that we were to sit in three chairs, located in the second row. Somehow we had become important guests at this mystery event. We discreetly asked the gentleman in front of us what was going on, and he cried “Oh! You don’t know about the program!” and a woman was quickly dispatched to sit next to us and explain what was happening. Apparently it was a health rally of some kind, a group of bicyclists had ridden for days all the way across India to raise awareness about healthy living, and Madurai was their final destination. We had stumbled into the finale celebratory rally. 

This guy ^^^ started out the show. It's fantastic, if you ever watch another thing in your life, watch this.

Yep, that's a mime show. And...aren't they technically in white face???

This performance was all about how we get so caught up in 'worship' that we loose sight of our unity as people. The guys in the middle represented the 3 world religions, they had a whole dance where they were fighting among themselves. The other two guys represent modern vices, one was representing "worship of alcohol and drugs" and the other was "worshiping technology". The last two guys (not pictured) represented a beggar who worships the man who gives him money. In the end they become enlightened by letting go of the differences between people and focusing on making themselves better people. 

I need to relate another anecdote from this adventure. It was evening, and the pavilion was well lit, so naturally the insects flocked. And by flocked, I mean SWARMED. I've never seen so many bugs in my life; there were your butterflies, your flies, your mosquitoes  your beetles, your bees, and your god  knows whats. And they were BIG. Flying every which way, running into and landing on people left and right. I looked down at one point and saw a huge blue bee sitting on my scarf, his legs were so weighed down by pollen he could barely fly. I was more amazed to see a blue bee than scared, so I held it up to show the woman next to me, who promptly swatted it onto the floor. After about 3 flying ants getting stuck in my hair and a beetle flying into the side of my head, I decided to cover my head with my scarf. But Stephanie and I were both still transfixed/horrified at the level of insect activity all around us. Pointing out particularly terrifying specimens to one another and jumping constantly at the slightest tickle, we could barely concentrate on the program! The people around us just chuckled kindly at us, we must have looked absolutely ridiculous, silly foreigners, jumping half out of their seats because of a little bug!

The demon moth of my nightmares. I thought it was a bat at first when it was fluttering around between the chairs on the stage, until it flew up and landed on the screen! This is the best picture I could get of it on my phone, but those people were sitting at the front of the stage, and the moth was perched on the back wall. I swear it was easily the size of a 5x7 photograph and at LEAST 6 inches across. Thank god it didn't fly directly at me (like most moths do), it just sat there taunting me... 

Monsoons- 

I mentioned monsoon season before, not to worry, the climate down south where I am stays pretty mild all year. But the way the weather can change is incredible. We Oregonians think we know rain... but its nothing like the rain here. One minute its sunny with blue skies, the next there's a storm with pounding rain and continuous thunder and lightning. I've never seen it rain here in the morning, but about half the days of the week there will be a heavy rainstorm that starts between 5:00 and 7:00 in the afternoon. Sometimes it goes for an hour, sometimes most of the night. And it's nearly always accompanied by thunder and lightening. Check out the videos I took from my office last week.

The O.R.

I get to observe in the operating room anytime I want here, which is amazing! 

They have pioneered a new system to maximize the amount of patients that can be operated on. It has been studied by researchers from Harvard and hundreds of other schools and businesses worldwide. But in order to explain it, I first have to tell you about piece of the machinery that makes it all possible, the sisters.

When the hospital began, the founders were struggling to be able to meet the demand for surgery. There simply were not enough surgeons, not enough operating tables, and not enough hours in the day. Then someone came up with an idea to make the hospital run with incredible efficiency, while at the same time promoting the welfare of girls in South India. Every year the hospital hires and trains close to 500 girls who have recently graduated high school to come work at the hospital. The girls come predominantly from rural villages, and most likely would be married right out of school. They are assigned to a specific job based on their individual skills, and given rigorous training in that area. Girls who have high marks and good technical skills are trained to work in the operating room, girls with good people skills are assigned the job of nursing, and so on. These girls, called “sisters”, make up the majority of the staff. They are the housekeepers, cooks, receptionists, bookkeepers, eye technicians, nurses and surgical assistants. The sisters are the backbone of the hospital, they perform the initial intake, accept payment, guide the patient through the process, do the initial medical exams, keep track of the patient case sheets and perform the counseling duties after the patient has been seen by the doctor. They are paid a good wage, some of which is saved for them, so that when they leave the hospital (usually 5-6 years later to get married) they have job skills and a substantial amount of savings. In this way the hospital is helping to empower young women to be self-sufficient. And as I understand it, having this career training reduces the amount of the dowry (if there is one) to be paid by the girl’s family when she marries as well, and makes her less dependent on her husband.

My favorite surgical sister 

Sisters performing vision tests at a camp

A sister from administration 

Some of the housekeeping sisters adding flowers to my hair for Navarathia

Sisters in the records department

The In-patient hospital waiting room 

This is where the sisters meet with patients for counseling after they have seen the doctor

So back to the operating room! Here at Aravind they have increased the number of patients that can be operated on in a day by tenfold. In essence the surgeons ONLY perform the surgery, they rest of the surgical procedure is done by highly trained sisters. The pre-op care is done in one room by sisters who do only that job, they prepare the eye for surgery, and then a doctor comes around and one by one administers a local anesthetic. The parents are then led to the operating theater by another sister and they sit outside the room until yet another sister leads them into the operating room and guides them to lay on the table (I call this sister the “escorting sister”). Another sister preps the patient for surgery, lays down plastic, clamps the eye open, and readies the surgeons tools. This sister is the most highly trained, she is the only one allowed over the yellow line on the floor that represents the sterile surgical space, I call her “the surgical sister”. She stands behind the surgeon throughout the procedure and hands her tools and occasionally moisturizes the eye surface. Another sister, I think of her as “the data sister” reads the surgical sister the patient’s chart, and brings up the case on the television screen for the surgeon to see. There are two operating tables for each surgeon, when they finish operating on one patient, they will immediately roll over to the next table, where the patient is prepped and ready for the first cut. The surgical sister summarizes the chart to the surgeon, and if they have any questions, someone will hold the chart up for them to read (because the surgeon is scrubbed and cannot touch anything that has not been sterilized). The surgeon will then perform the surgery, and then roll over to begin again with the next patient, who is already prepped and ready. The surgical sister will then clean and bandage the eye, and the escorting sister will lead the patient out to the post-op recovery area. That is how they are able to operate on so many patients. It’s like an assembly line process, three sisters are assigned to each operating table (an escorting sister, a data sister, and a surgical sister) and the surgeon just goes back and forth between tables, allowing them to move seamlessly from operation to operation with no lag time in between.

The vast majority of procedures they do here are cataract surgeries,  I've seen so many now, I feel like I could perform one in my sleep. 

India just finished celebrating the holiday Navrathia,

in which 3 different goddesses were celebrated for a period of two days each. The last two days were of particular importance to the hospital, as it was in celebration of the goddess of learning/study. There was a very elaborate ceremony, where many of the doctors brought their tools (microscopes, laptops, scalpels, etc.) to be blessed on a table heaped with incense and fresh fruit , below a picture of the goddess. It was amazing to be a part of, people have been so excited about sharing their beliefs and traditions with me!

We know we have it good in America, but you can't realize just how good until the water that comes out of the faucet isn't even safe to brush your teeth with (and you're among the most privileged here to have that), and when you can't buy produce at the grocery store because anything you can't peel or boil might not be safe to eat. Just the fact that you can read these words makes you more fortunate than 70% of  the people here. It's been an eye opening and humbling experience so far, I hope from here on out I will be able to "sweat the little stuff" less often, and focus on what's really important! 

Here is an adorable picture of a puppy... I couldn't help but play with him a little of course, and he followed us and kept tugging on my scarf and pant legs until a shopkeeper came and shooed him away!

I got to meet an elephant tonight!!!

We were having coffee with a friend and I mentioned how badly I wanted to see an elephant, her husband happened to know of a temple nearby where an elephant lived. So we jumped into a rickshaw and headed over to the temple of Vishnu.

The good news is there was a ceremony starting just after we arrived, the priests were carrying the god through the giant temple, followed by a long procession of worshipers, drummers, trumpets and incense carriers. The not so good news is that the elephant was required to lead the procession, so we had just a few minuets to meet her before she had to go to work.

She is 56 years old! Being so close to such a gentle giant was an experience unlike anything else.

We knelt in front of her and she "blessed" us by touching our foreheads lightly with her trunk.

The start of the procession

After that we toured the temple. We were even allowed to climb all the way to the top, where foreigners are not usually allowed because its considered an especially sacred space.

The Village 

Today I had the opportunity to visit with school age children from a small village in Madurai. I Did not really understand what was happening at first, a doctor here asked me if I wanted to "visit the village with them", and I agreed. So I show up Saturday morning, and there is a bus filled with children. Still no clue what's going on. We drive about an hour and a half, through beautiful jungle countryside and lush rice fields, until we reach a very small, obviously very old, village.

At this point I just have to say, Ive heard a lot about how beautiful India is, but I hadn't really seen that just going from city to city. Along this drive I began to understand. Every shade of green imaginable; beautiful forests, palms, banana trees, and coconut trees as far as the eye can see.

 I, the two doctors, and the bus full of children are escorted into a small building where close to a hundred children were sitting on the floor. The doctors and I were led up front to sit on the edge of a stage, with all those little faces staring at us.

So I guess the purpose of the visit was for the 'urban' and 'rural' children to meet each other and learn more about each other's lives. The village children drew pictures for the city children and the doctors had brought bags of toys and gifts for the urban children to give in return. 

The teachers asked each of the children to introduce themselves,  and then led discussions in Tamil that I couldn't understand. About what their lives were like, how they helped out around the house and so on. So im sitting at the front of this room, with all these curious little eyes staring at me, with no idea what is being said, trying desperately to look like I was paying attention. 

The doctor next to me gets up and addresses the group of children for a few minuets, and then everyone turns to face me... they asked me to stand up and say something to the children, because hearing from me would make it such a memorable experience for them... "What should I say?" I ask. "Anything you want" they tell me, "Just give your impression of the event so far, we will translate for you". So i'm standing up there thinking, "what is my impression of this event?? I have no idea what anyone has been saying!" So finally I just say "Hello, my name is Katie, I am a student visiting from the United States. I am working at Aravind for the next few months... and I am very excited to meet all of you". 

The official part of the event ended after that, and the children were allowed to mingle and play with one another for a few minuets. Immediately a small group started nervously inching over to me, until one girl was pushed forward by the others. I smiled and asked her her name, and then there were a hundred children around me in an instant, all wanting to shake my hand and tell me their names. 

The teacher wanted to take a picture of me with some of the children, so she asked me to sit down and then had the children sit around me. They kept tapping me on the shoulder to tell me their names again and shake their hands. One girl shying touched a lock of my hair, and another wanted to feel my toenail polish. The only English most of them understood was "What is your name?" and they would ask me "How are you today?", but that was about the extent of it. 

See this is what im talking about, people here don't smile in pictures! This whole group of children was talking, laughing and all trying to ask me questions simultaneously, then she said "say cheese!" and you would have thought most of them just came from a funeral!

In this one I was like "why dont you guys smile for pictures here?! and they all thought that was pretty funny.

It was such a strange feeling, one that I have experienced everyday here, but not on such a large scale, basically just being important to people for no other reason I can discern other than the fact that I am foreign. I must have shaken each child's hand a dozen times and answered "How are you today" at least 50 times.  

All in all it was a wonderful experience, the teachers were able to translate some for me and I asked the children all about what they were learning in school and what they liked to do for fun. Interestingly, they seemed very puzzled when I asked them what they wanted to do when they grew up. At first I thought they didn't understand the question, so I tried saying another way. That's the first question you ask a child in the US, and they will instantly rattle off that they want to be a firefighter, or a veterinarian, or the President, or all three! But the teacher shyly told me that these children didn't know, or didn't think about that. They wanted to know from me how far I was in school, what I was studying, and when I was coming back to India. Can you imagine, I've just told them i'm going to be here for three months and then ill be going back to school in the States, and their response is "when will you be back?" and "will you come visit again?". 

I promise to be better about updating more frequently now that I have a camera again! I want to introduce some of the people I have had the pleasure to meet here, and talk about the food as well! I've heard that it's difficult to post comments here, but my family has assured me that you all like seeing my pictures and hearing about what I am doing. I enjoy sharing my experiences with everyone! I miss you all very much! please keep in touch, all of your comments, likes and emails mean the world to me :)

Namaste,

Katie