Rural dusk

Life at dusk in rural Mysore is incredibly beautiful. So beautiful, that it's easy to completely forget that life here is so far from perfect.

Unfortunately, my amateur attempts at photo-documentation leave much to be desired. You're probably just better off closing your eyes, imagining a warm breeze, women in saris gracefully walking home carrying enormous stacks of firewood on their heads, kids doing their homework in corners, and an ancient woman inviting a foreigner in for tea.

Broken roof, broken foot.

This week I returned to Ekalavyanagar, the village that was the site of our health camp last month. What we found was a broken roof, and a broken foot. Where there had once been at least marginal protection from the sun (if not the rain) over the preschool, there is now an entirely collapsed structure. PHRI had hoped to maybe help the village build a roof one day. But now, without much in the way of walls, or even toothpick-like poles, the task of providing a sturdy structure for preschool seems even more daunting.




And the broken foot is a red, swollen, painful, immobile ankle on a little boy alternately limping around with a stick and being carried by his grandmother. The story is a bit vague, but a month ago it was either stuck in a bicycle, smashed by a rock, or suffered some other calamity. Either way, it's healing remarkably poorly, can bear no weight, and hasn't been able to get this little boy to school.*



At the end of our visit we wandered towards the back of the village. What we discovered was a group of migrant workers even poorer than the rest. For baffling and bureaucratic reasons they haven't even been able to get ration cards, and there isn't enough to eat. Yet, the giggling, scrambling, half dressed kids were just as excited to have their pictures taken as any others.

*Owing to technical difficulties on the part of my aging computer, two weeks have elapsed between the writing and the posting of this entry. In the interim, my intrepid co-worker Sylvia, and the several grams of amoxicillin she brought back to the village after our visit, have gotten this little fellow back on his foot.

Driving in India

Don't tell my Mom, but I have now ridden on the back of several Indian motorcycles. It is a truly terrifying experience. When I first arrived in India I imagined that although the traffic was terribly fierce, maybe it wasn't actually that dangerous. I had hoped that, although it felt like buses were driven with an alarming recklessness, that they were somehow guided to safety by a benevolent spirit. I've since learned that sadly, this isn't the case. India drives 1% of the world's cars and suffers 10% of its motor vehicle fatalities.
The worst part of the newspaper here is the daily list of fatal accidents. The descriptions tend to sound like "In an unfortunate incident between a bus and a cliff, 20 dead, 30 mortally wounded." I remind myself that the only thing worse would be if they didn't write about it.
So why would I keep getting on subcontinental motorcycles? Because they are driven by my friends, who take these risks every day, to get to work and see their families. In the US I live with a security that's hard to even imagine in India. Who would I be to refuse to live, even for a moment, in a world as unpredictable as the one a billion people inhabit here?

Indian wedding

When I was invited to join 999 of my closest friends at the wedding hall next to the Mysore Milk Dairy to celebrate the union of my favorite sari shop owner and his gorgeous bride, I had no idea what to expect. I had absolutely no idea that my first task would be to pose with my co-worker Bhavana's family, the couple du soir, and several assorted other guests. Nor was I in any way prepared to eat a dinner scooped out of buckets onto banana leaves by energetic waiters dressed in matching pink. And who knew that despite the exhausted looks on the faces of the bride and groom, they hadn't even been married yet? The wedding ceremony wasn't actually scheduled until the next morning. Following suit, I wished them the happiest of married lives, enjoyed the music, and pretended that I often spend my weekends wearing a sari, scooping chutney off a banana leaf.

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.

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.

"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."

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."

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.