Tuesday, October 28, 2008

A traditional birth

I have now spent two weeks traveling to villages in rural Mysore, meeting Traditional Birth Attendants. I realize that I've started to fantasize about actually seeing one of these beautiful, brave women deliver a baby. Piecing together a picture from the stories they tell us, I imagine a woman in labor in a cow shed, or her mother's home. She is surrounded by female family members. Someone is boiling water, preparing to sterilize a blade and string. The TBA is rubbing oil into the woman's belly, squeezing when the pains come. Obviously, I'm glorifying, there's no epidural anesthesia in a cow shed, and there's very little to do when something goes wrong. This is why we also hear stories of breech babies born still, and mothers suffering fatal hemorrhage. And, as incredible as it would be to see a newborn covered in cow dung, I know this is also a good way to get botulism. Every woman deserves a safe delivery.

Tuesday, October 21, 2008

Building trust


When we go to the rural villages of Mysore, our first, and probably most important task, is building trust in the community. There is a long legacy of medical mistreatment, including sterilizations, and rumors of stolen kidneys. The villagers have several good reasons not to trust anyone. Therefore, our first stop in each village is at the preschool. We introduce ourselves to the teacher, and learn about the goings-on in town. In Chikkahalli this helper shows us the lunch she's making for the kids.


We also struggle with conflicting notions of privacy, trust and community when we interview the Traditional Birth Attendants. My research background, and four years of medical school tell me that if I'm going to be asking someone questions about illegal abortions, she better be in a confidential space. But, I'm learning that in these close-knit villages, asking someone to speak alone to outsiders, especially a foreigner, is an incredibly uncomfortable proposition.

In Chikkahali we do our best. And at the end of the day, when our van gets stuck in the mud, many of the village elders (and youngsters), come to help us get it out of the swamp.

Mr. Obama, you have my vote

You've had it in spirit for a long time now, but I couldn't quite figure out how to make it count. And then today, page 5 of The Times of India revealed the existence of something called the "Federal Write-in Absentee Ballot," for Americans living abroad. Turns out, I can be twelve and a half time zones from my voting precinct, my absentee ballot can be loitering somewhere around Polk and McAllister, and I still get to vote! What a great country.
Entrusted to the fine folks at India Speed Post, it's heading in your direction.
Democratically yours,
Sarah
P.S. I'm glad you're taking time off to be with your Grandma, everyone should be able to do such a thing.

Sunday, October 19, 2008

"Rama buys a cow"


My favorite discovery of the day is the existence of this mimeographed, 160 page handbook, which promises to be "the easiest way to learn and know Kannada." It has already given me so many new and exciting ways to discuss cows. I also particularly enjoy page #126: "Telegrams." I can now wire anyone, and wish them "both happy prosperous wedding life."

Saturday, October 18, 2008

Executive Lunch

Owing to another lengthy discussion about the freezer, and several other distractions, I don't make it to lunch until late in the afternoon. I'm wickedly hungry so I go huge, and order the "executive meal" for about a dollar. It's a veritable extravaganza of delights on a sectioned tin plate.


There are many things I'm coming to love about eating in India. In particular, I'm delighted by the very slight variations on a basic tortilla theme that show up at every meal. They go by such pseudonyms as chapatti, parotta, and poori, but they're even kept in tortilla warmers, I remain unconvinced. Someone told me once that "all the world loves a flat bread." So true.
The people I've met in Mysore have an incredibly generous urge to feed. My co-workers spend much of the morning discussing what everyone brought for lunch, and the minute the lunch-pails are cracked, everything is openly shared with right-hand nibbling gusto. They giggle, and tell me "Eh, we think you should eat cashews. Too thin."

Friday, October 17, 2008

Health camp

This girl really is this pretty and charming, and really does get dressed in a house that looks a lot like this in the morning.





I went with the team to my first "health camp" today. It's the kind of thing that in San Francisco might have a bit of physical presence, with maybe a tent or a van. We just roll on into the partially-roofed preschool, set up some of the ubiquitous plastic chairs that seat much of India, and start seeing patients. The patients are lovely. They're kind, pleasant, and graciously respond to all six of the mangled words in my Kannada lexicon.
Overall, the clinic is pretty challenging. The 19 year old mother of four sitting two feet away from where I'm struggling with a blood pressure cuff, is actually having her visit with Dr. Bhavana. It's hard to imagine how confidentiality can happen here. And prescribing a chronically malnourished, pale-under-the-eyelids anemic woman 20 days worth of multi-vitamins also feels woefully inadequate. Really, I'd like to prescribe a lifetime of ice cream sundaes, with iron flakes on top.

Wednesday, October 15, 2008

The freezer


I spent a decent amount of my day talking about a freezer. Specifically, a freezer capable of maintaining an arctic -80 degrees. This seems to be the temperature that human biologic specimens like best, and what you need to run a lab. Someday PHRI is going to have a fantastic lab, that tests for the sexually transmitted diseases that affect poor women all over the Mysore Taluk. Right now we have a freezer in the basement, and a washing machine in the lab. Turns out, it's not easy to get a -80 freezer up and running, even in San Francisco. Fortunately at the City Clinic were able to give up and just sent our business to Stanford. Here, we need approval from the Karnataka Electrical Board to get more electricity from a grid that fails a couple times a day at baseline, a signature from a landlord who apparently resides on the other side of the planet, recognition as a charitable organization to make it affordable, a special vent installed, and an electrician to give us his blessing that we can turn it on without draining the entire neighborhood. It will happen, it will be great, and really really cold.

Tuesday, October 14, 2008

I get dressed

It took three PHRI staff several persistent hours, but I finally have an acceptable wardrobe. They inform me early on in the day that I'm going to need to let go of my moody San Francisco tendency towards black. In India, the brighter the better. The only thing holding back the sequins is the sheer weight of a million of them attached to 5 meters of sari fabric. I finish the day with outfits in several fantastic technicolors. As the experts were draping me in my turquoise sari my only concern was finding an occasion suitable to wear such a glamorous outfit. Fortunately, the sari store owner is getting married, and I'm invited.

Monday, October 13, 2008

Murudagalli

Today is my first day visiting one of the rural villages in the Mysore district. Our first stop is at the preschool. The government provides each village with a preschool and a teacher. The teacher is responsible for not only the care and well being of the village's near-toddlers. She also does weekly surveys of the health of the village, and has the most current count of pregnant women. The most remarkable part of the whole operation is the 20 children who sit quietly waiting while we talk to her. Having fairly recent AmeriCorps experience attempting to corral American kindergartners into "circle time," I'm totally amazed.

In the village we survey women about their birth and pregnancy histories, and then identify and interview three Traditional Birth Attendants (TBA's). This woman tells us about reviving
babies who aren't born crying by placing cow dung on their bellies and umbilical cords. We give her a few of the several hundred "birthing kits" I didn't declare at customs on my way into the country. Each kit has gloves, a plastic sheet, a clean razor, some soap and string.

It's hard not to notice the sweaty, febrile, ill-appearing child quietly moaning in the lap of her TBA/greatgrandmother. The family tells us they plan to take her the 16 kilometers to the government hospital in Mysore that afternoon.



Sunday, October 12, 2008

The neighborhood


I start my first day on my own in Mysore with breakfast in the hospital cafeteria down the road from PHRI. I have four options, I vaguely recognize one of them, masala dosa. I order it. It's a big crepe, filled with a spicy potato mixture. I'm sure it's exactly what they're feeding the hipsters at Dosa on Valencia Street on Friday nights. Here, it's breakfast. It's delicious, and I'm fairly certain I'll have another opportunity to order it tomorrow.



I then head out to explore the neighborhood. After two weeks of traveling in India, I've come to accept that urge to photograph everything is powerful. However, so much simply can't be captured on pixels; the fierceness of driving, the sheer density of billion people, the number of well-behaved children everywhere, the slightly hungover atmosphere that greets us in Mysore at the end of their Dussera festival. Everyone in town wants to know if we've seen "the procession." (We missed the procession, but still got to see the prized, decorated, elephants lazing around the palace grounds.)

A few blocks away I discover my local Hindu temple. It's full of people milling around, has it's own drum group, and background soundtrack playing to an entirely different beat, and a double dose of flashing neon. It's a little bit of Mysore meets a casino in Reno, Nevada.




Later, I wander to the alley next to the temple. Several stands are selling what I would have to best describe as Indian leis. I've seen these strands of flowers decorating boats, trucks, statues, and the best of the blinged-out auto-rickshaws. I'm sure they have a name, and a religious purpose, and a traditional way of being made. However, at the moment my grasp of Kannada (the local lingo) doesn't extend much beyond "hello" and "goodbye," So these are mysteries I'll have to solve another day. Today, they're bright, colorful, and smell fantastic. I buy one, take it back to my new home.