Tuesday, December 14, 2010
Saturday, December 11, 2010
We all boarded an old bus a little after 8 am and drove to a small village about a half hour away. The roads are paved until you get close to the village, when it might turn into a narrow dirt path. Two vehicles meeting makes a good photo. There are about 25 doctors on the bus (many with friends and relatives in the US). All the way to the village they chant and sing responsively. One doctor volunteers as the leader, and later another takes over. They all are familiar with the music and clap and have a great time.
The landscape is quite beautiful in parts, with paddies and mango orchards close to the narrow road, and hills in the distance, some with interesting rock formations toward their crests. This is a good year because of the heavy monsoon rains, but there are also drought years when it's hard to see how the farmers get by. It used to be that virtually all the land was owned by one or two families in a village, and the villagers worked for them. Now there seems to have been some land redistribution and many of the villagers work for themselves. The road is dotted with small cemeteries. It seems that young people not yet married are buried rather than cremated, and sometimes a family will put up a slab monument to someone who was cremated. I have yet to get a picture of the heavily laden ox carts that pass by. The fields are full of big stacks of what looks like wheat but is in fact rice. The stacks are the size and shape of Quonset huts and are usually covered with blue plastic tarps because of the rain.
The village we worked in this day had a population of about 1,000, which may be typical. As is often the case, we took over the school rooms for the clinics. Everything was already set up by the time we got there. As with everything in India, the clinic starts with something spiritual. In this case we all lined up, men on one side and women on the other, for a short ceremony that seemed to involve asking swami to bless the endeavor. Between the two rows of doctors there were about 100 patients sitting on a ground cloth, in this village all women. There are Muslims and Hindus, living together in apparent harmony. Everyone gives thanks and then some ash is distributed to the doctors, who put some on their throats and foreheads and eat the rest. I was included in this. The ash is blessed and/or made by swami. All the doctors are completely devoted to swami and feel that he is watching over their work.
The mobile hospital is astounding. All these doctors work for free. Some have even retired early from paid jobs to volunteer their services for swami's hospital. Others have practices but devote volunteer time too. The Sai Baba specifically asked the mobile hospital director to take the job. He seems like a charismatic and caring person. Another man got a green card to work in the US, but returned here because he preferred to work for free for swami. They talk all the time about how the spirit and blessings of the Sai Baba are with them and have made all this possible. For example, they claim that there was no bleeding in the case of some LEEPs they have done, which would be most unusual for this as all surgery. The explanation is that the swami made this possible. Besides the gynecological clinic, there is a well stocked pharmacy, general surgery (they do anything that does not require general anesthesia), dentistry, cardiology, general medicine, opthamology, etc. The mobile unit itself has an X-ray machine with dark room, some sort of scanner or sonogram, and a well equipped pathology lab that does cytology and histology (I think I have that right). They would like to do more health education consistent with a philosophy of treatment and prevention guided by spirit.
They are only just getting into maintaining medical records from which epidemiological studies could be done, e.g., determining the population subject to certain diseases and the penetration of the mobile hospital's services. The general practice is that medical records aren't even maintained by the hospital. Rather, each patient has a little notebook in which things are written, and/or they get a little slip of paper telling them when to return. The patient is responsible for maintaining the record, in other words.
In the US we throw out needles after use. That is not necessarily the case here, so health care workers are still subject to needle sticks and all that goes along with that.
Rhoda saw patients but I observed this day because we were not originally scheduled to come. Many of the old people have very skinny legs and need walkers, which is most evident on the men because they wear dotis (like Gandhi). This apparently comes from eating not much other than white rice all their lives. Many have poor teeth and brittle bones because there is too much fluoride in the local water. They are also subject to loss of pigmentation; I saw one women whose face was completely white. A man or woman who is 65 is considered pretty old, and it was generally observed that Rhoda and I did not look like we were so old (Rhoda is 63). Indeed, in shape older Americans are doing and looking much better than Indians. The young people, particularly the women, are thin and graceful, some even strikingly beautiful. But they do not age well. After childbirth their bodies lose their shape and they seem to do nothing to get their figures back. They do no exercise other than what their lives demand. This is true with middle class Indians also. All the village women have gold earrings, a marriage necklace usually with some gold in it, a gold nose pin with little diamonds, perhaps a gold bangle, and lots of plastic bangles.
I want to say something in favor of saris. All the village women wear them. First, they are one size fits all. They can be inexpensive yet look great on the village women. The more sequins the better. They are flattering to most shapes. They are perfect for pregnancy, you just wrap yourself a little looser. Depending on the weather, they can be warm or cool. One doctor told me that although she sometimes wears western chothing, she prefers saris. The Muslim village women wear black caftans, under which they wear bright saris. Without the caftans they are indistinguishable from the Hindus. Village women do not wear underwear. When they have their period they bleed down their legs or onto the petticoat that is worn under the sari.
The primary means of birth control is having a tubectomy after two children, although there are exceptions, e.g., for some people who do not conceive a son. If there is anything wrong with the reproductive organs the first option is usually to have a hysterectomy. The doctors I am with believe this is because of the money private doctors get to do these operations. One of the things we are trying to do with the cryo and LEEP procedures is to discourage hysterectomies in favor of much more conservative treatment.
I will have some wonderful pictures of the villages because no one minds photos. In fact, everyone wants to be in them. I took a photo of some adorable children and it seemed like every child in the village suddenly materialized to be part of the picture. I showed the photo around with my camera to great hilarity. The kids mobbed me and all wanted to shake hands and say "sairam," the general greeting around here that always gets a response, especially if you put your hand to your heart or put both hands in prayer position in front of your chest. I ended up shaking about 30 tiny hands.
People chatted happily on the bus ride back. Deborah
- Villagers who are jubilant about getting 24/7 power for the past couple of weeks fear they will be back in the dark after local elections. Reliable power would allow them to harvest a second, summer crop. But they are afraid to make that investment because they will suffer a financial loss if the power is curtailed after the election, which has happened in the past.
- The principal of a Catholic girls school ordered about 50 students to clean wooden tables and benches they had allegedly defaced. But instead of giving them cleaning liquids, the girls were provided with concentrated nitric acid and small cloths. Students were burnt within seconds and admitted to a hospital. They may have severe and permanent injuries. The school would not permit the girls to tell their parents what had happened for hours. The administrator of the Archdiocese of Hyderabad has denied that the incident occurred.
- A former state chief minister and his cronies pocketed 60 million rupees, which his son is trying to turn into political power by using it to set up a new party.
- Fake Naxalites (Communists I think) have been extorting money and killing people with weapons procured in Bihar. I guess they thought revolutionaries had a good thing going.
- Two students drowned in a cesspool caused by deep mining in the area.
- The new chair of rehabilitation centers in the state plans to tackle organized beggary, which is run by goons in collusion with law enforcement. Gang leaders pay beggars daily wages and receive the day's collection. They operate in - you guessed it - railroad stations, traffic junctions, temples, and markets. Existing rehabilitation centers are being used by people from well to do families. His goal is to eradicate beggary. Good luck.
- It has been discovered that millions are being misappropriated each month by 6,000 welfare hostels that inflate student strength in order to collect extra meal expenses. Meanwhile, the food is of poor quality and hostel maintenance is unsatisfactory.
- 21 teachers have been dismissed for failing to show up at work for more than a year without good cause or permission.
- The health department has ordered compulsory retirement for the president of the employees' association, who was found guilty of misappropriating money meant for life saving drugs.
First the important news -- Deborah looked smashing in a sari yesterday! She borrowed one from Rhoda and wore it to our village of the day.
We are receiving much support and encouragement to continue building towards a sustainable, locally operated train the trainer centre in Mysore. We spent an evening with Rotary International leaders in Mysore, and they were quite encouraging of us to send them a proposal for local support of various kinds -- I am working on that proposal now. The next evening, we hosted a dinner for 30 of the most senior members of the gynecology community in Mysore -- Senior professors from the two primary medical schools, senior administrators from the Cheluvamba Women's Hospital, senior physicians, our wonderful trainees, and even the District Health Officer (DHO). We shared our goal of a locally operated centre for training health care workers to carry out VIA and preventive treatments -- to be established by 2013. They were also quite encouraging.
We will spend Monday and Tuesday in Vishakapatnam (NE Andhra) exploring possible PINCC-India involvement there. There is a large steel company there that operates a general hospital. The Sai Seva organization would coordinate outreach and patient education and bring village women to the hospital for VIA etc. The doctor there (Dr. Suryaprabha) has been trained by Rhoda and Kay at the SSSMH.
I also forgot to mention something that will be of interest to Anna: on the last day of the camp they brought us a cervical fibroid cyst they had just removed from a woman. It was the size and apparent consistency of a coconut! I think they said they'd had to do the surgery in two stages, first to deal with circulatory issues, and then to remove the "coconut," but I'm not sure about that. They had had her in the hospital under observation for several days while they prepped and figured out what to do. Obviously there was no cervix left. It had probably been growing inside this woman for years.
After breakfast Dr. Rhoda and John took me on a tour of the ashram. Warning -- if you read further you are going to learn way more about the ashram and Sai Baba than you ever need to know. It is very big, perhaps bigger than the old city of Jerusalem. It seems to be funded by a variety of trusts and sub-trusts, about which Rhoda and John know little. They do know that the guy who owned Hard Rock Cafe donated $25 million fairly recently. Someone in the TATA family is also a big supporter.
There must be at least 100 buildings, more every year. Nice gardens, meditation areas and little shrines pop up here and there, but one wonders whether eventually they will cover everything with buildings. There are at least 2 massive buildings for ceremonial gatherings of thousands of people, such as the darshan. There is a book store that sells only books about Sai Baba, in about 60 languages. Devotees are encouraged to write books about their personal spiritual experience here, and there is an in-house press that prints them. One of the nicest buildings is the book depository across from the book store. There is a shopping center that sells food and clothing. There are separate hours for men and women to shop. Even the entrance to the ashram has separate lanes for men and women. There is a museum of religion and a fairly powerful radio station. There is a medical clinic for women named for the Sai's mother, a hospital, and of course the mobile hospital vehicles that we will be using when we go to the villages to deliver our screening services.
There are three places to eat: the western canteen, the north Indian canteen, and the south Indian canteen. Everything is vegetarian. We ate lunch at the western canteen. I had a bean dish, fried veggies and pasta. The pasta was terrible. The kifir drink was delicious. It all cost about $1, and this is the most expensive of the three canteens.
There are many 3 story concrete accommodation buildings. Rhoda and John borrow a unit from friends who have fixed it up nicely. They pay 40 rupees/day, which equals about $1. The units are allotted to people in some fashion, not owned in fee. Perhaps there is some "ownership" arrangement like in assisted living, but I don't know. There is A/C in their unit, which is rare. It is one room about the size of a large hotel room, western bathroom, plus a little western kitchen. They have had the walls paneled in a varnished wood, into which are built closets and drawers, very tidy. The units come originally quite basic, with only cold water, but you can fix yours up as you like. Their unit has all the creature comforts, including a cleaning lady whose two children are being put through schools by the owners of the unit. They have also set up a savings account for her into which they regularly deposit part of her wages.
The accommodations run from palatial for VIPs such as the Prime Minister to open concrete warehouse structures with bunk beds and mats on the floor. There is a fancy hotel on the grounds for important people; Goldy Hahn stayed there, but people like us could not. The Sai himself lives in a large, decorated, multi-story building with terraces; looks real nice. Several of these warehouse type accommodations were build this year for the celebration of the Sai's 85th birthday, to which certainly 100's of thousands of people came. The Sai discourages belief in the caste system, but as you can see the housing here is very hierarchical. Or you could interpret it as creating availability for all people, regardless of income level.
There are designated living units for volunteer pilgrims who come from all over to work at the ashram for 2 week stints. Many of these people seem to be Nepalese at the moment. They perform mostly security services, standing and sitting guard in the buildings, greeting everyone with a "sairam," and touching their hand to their heart. There is a lot of security all around and in the ashram. I had to go through a metal detector to enter and they did a very thorough manual search of my purse, probably because I was carrying a metal spoon. As I've mentioned, I don't like eating with my hands. Everything is painted yellow, Pepto Bismal pink and light blue.
The ashram is here because this is where the Sai Baba was born. He is the reincarnation of the prior Baba, who died eight years before Sai Baba was born. That avatar was born south of Mumbai, so that is where his headquarters remain, and he still has many devoted followers, perhaps more than Sai Baba. Eight years after the Sai Baba dies there will be another incarnation, which will usher in a period of love and peace on earth. It is a little like the Tibetan system for selecting Dali Lamas, except that the Sai Baba designated himself as the avatar of god, whereas others identify the Dali Lama as a child. His birth story is similar to the story of Christ. When his mother was pregnant she was hit by a bolt of lightning. Although she gave birth to him, he is not her child, but a god being. He acted differently from early childhood. At about the age of 9 he revealed that he was the avatar of god and incarnation of the earlier Baba. The Sai Baba is regarded as at the same level in the spiritual cosmos as Krishna, or perhaps even Jesus. The way of life he espouses is about doing good, doing no harm and loving. It is not seen as a separate religion, but is welcoming to all religions. In other words, you can be a devotee and still practice your own religion. There is great concern about what will come of his movement when he dies.
I spent much of the rest of the afternoon writing up the three days I sent to you yesterday, sitting in the western cafe I described. It was very pleasant. We ate dinner there. Before dinner I went back to my hotel and managed to get my laptop fixed so I could use the Internet in my room. A very nice fellow changed the IP address and that seemed to do the trick. They also sent up a TV technician to check why I cannot get English language stations. He fooled around with it for a while, but the truth is the hotel has not invested in the package that includes such stations. One wonders why they didn't tell me that to begin with. Anyway, dinner was delicious. I had salad (this may be the only place in town that for sure washes veggies in filtered water) and pizza, and a tiny, first rate chocolate mousse. The restaurant features what may be the nicest western toilet in rural India, a separate reason to hang out here. The meal was relatively expensive - about $6. Deborah
It turns out that the bible does say that god wants the Israelites to remove their "adornment," just as sister said. However, if you read the passage in context, it is clear that what god really wants is for the people to put aside their pride - god calls them a "stiff-necked" people - so he can see who they really are. I think this woman could safely wear jewelry without jeopardizing the purity of her soul. She brought her younger 16 year old daughter to meet me because she thought I was "so good." This was quite touching. Both of sister's daughters will go to college, studying computer science and engineering.
The clinic went very smoothly again. We saw 40 women. Unfortunately, we were unable to do a LEEP procedure. This is unfortunate because it makes it impossible to train the trainees on the procedure on a real woman. Training on a piece of meat is not quite the same. We have our fingers crossed that there will be opportunities tomorrow.
The special event of the day was an appreciation/networking buffet dinner PINCC sponsored for the trainees, supporting doctors, and health department officials. About 30 people came and we did the best we could to encourage the development of an in-country screening program based on our protocol.
Friday, December 3, 2010
Day 1 - Mysore
The day started with a visit to the government hospital where we will be working to make sure all was in order for the clinical training starting the next day. We will have a spacious room with 3 examination areas, which is ideal. This hospital treats the poor for free. Relatively few can afford the private hospitals. Patients do not make appointments, but come and wait on the grounds for someone to see them. Most are illiterate. They sit on the ground in clusters talking with each other and many are with their children. There are only wards in this hospital, with white metal beds and thin mattresses. Patients are expected to have a relative or friend stay with them to procure food, give comfort, and provide miscellaneous services that paid professionals would normally provide in the States. Most of the health care personnel are women, but men seem to occupy many of the leadership positions.
We spent the rest of the day preparing and being present for Rhoda's presentation at the medical college. The format was a continuing education program. It was very well attended, perhaps 150 people. There were post-doc students who all sat in the back, professors who sat in the middle, and honored guests (like me) who sat in front. Virtually all the women professionals wore beautiful, and I mean beautiful, saris, with diamond and gold jewelry. I have to say that one of my strongest impressions of the day was the exquisiteness of the women, the gorgeousness of their clothing, and the realness of their jewelry. I was wearing one of my borrowed cotton outfits with repatriated silver earrings, and I was way under dressed. The most poorly dressed attendees were two Berkeley grads who are working as interns for the summer at PHRII (Public Health Research Institute of India) with which we are associated in Mysore, getting ready to apply to medical school in California.
Half a dozen people helped set up for the presentation. A technician tested the sound system for 2 hours. The presentation itself was preceded by a catered lunch of Indian food for all the attendees. The program started at about 2:15. The first half hour was all about thanking certain attendees, i.e., health care leaders, and giving them flowers and gifts. Rhoda was of course included in that, and even I got flowers. There was an invocation, including two women chanting a lovely song from the dais, and a butter lamp ceremony involving lighting wicks in a brass stand that had been festooned with little flowers. This all took place in a small amphitheater in the medical college facility, which had apparently been funded over the years by Indian doctors in the US. They all had their photo portraits in the entry hall.
Dr. Rhoda was a terrific speaker, in part because she so obviously spoke from the heart. She explained PINCC and what we do, the high prevalence of cervical cancer in certain countries including India, the cytology/pathology of the dysplasia and cancer (think graphic slides in the Power Point presentation) and the importance of preventive screening. John followed with a short presentation about the commitment needed to establish cervical cancer screening as a government priority. Preventive medicine is not widely practiced here. The doctors in government service tend to be overwhelmed with acute care. One high level doctor explained that the reason PAP smears are not regularly done here is because there is no one whose job description includes transporting the slides to the pathology lab.
The program ended at 4:30, at which time a drug company representative gave a pitch for a particular brand of calcium with vitamin D that included lots of data about vitamin D deficiency and its bad effects during pregnancy. I have read that most Americans suffer from vitamin D deficiency, including yours truly in the past. Indians and other dark skinned people are particularly susceptible. There didn't seem to be anything special about this particular product, and many people quite reasonably walked out, having already completed the professional education requirement.
The weather is perfect, slightly humid tee shirt weather. The evenings are a little cooler, so you don't need AC or even a fan.
We are staying in a very "real" neighborhood in Mysore. We are in a basic but clean and comfortable small hotel. My room has 2 single beds, a desk, free wireless that works instantly, a TV with all possible channels, several chairs, AC plus ceiling fan, private bath, and a little kitchen with a breakfast table and chairs. It is quite spacious. There is some street noise, but nothing disturbing.
Day 2 - Mysore
Today was the first day of the PINCC clinic. We had a large room so there was space for reception and registration, gathering patients on floor mats for informed consent and education by the social worker, taking histories, recording everything in a computer data base, three exam tables, paper file maintenance, slide arrangement for smears, little cups of formalin for biopsies, and a separate room for sterilizing the speculum, retractors, biopsy tools, and other equipment. The latter turned out to be my special task. The used equipment is picked up from each examination area and washed grossly by a maintenance person, who puts the stuff in a tray of cleaning solution. I then inspect her washing and return pieces to her for re-washing as necessary. After soaking for awhile, they go into boiling water for 20 minutes.
Again, the clinic or "camp" was preceded by a butter lamp ceremony to bring auspicious spirits to the endeavor. We saw 44 women. We had six trainees. We expect additional trainees will participate tomorrow.
Rhoda is an awesome teacher. She is patient, clear, pleasant, and conveys gratitude to those who want to learn. What is special about our protocol is that we can do everything in one visit, including telling the women the results of the screening most of the time. This is hugely important for countries like India, where the women are bussed in to our clinic from distant villages and can't afford to return again and again. An important distinction is that we do a low tech, low cost screen with diluted acetic acid before PAP smears, so most of the women don't even have to have a PAP for pathology. We can do biopsies, cryogun treatment (destroys pre-cancerous cells by freezing them until they explode), and even LEEP (a surgical procedure more invasive than cryogun and involving excision of tissue with an electrical current). PINCC donates the cryogun and LEEP machine when we feel the clinic personnel are adequately trained. The Indians would like to have colposcopy machines, which are expensive, widely used in the US, but really only magnify what you see with the naked eye.
The camp is running exceedingly smoothly because of the excellent facilitation, collaboration and services of PHRII, a foundation that has accomplished amazing things in its five years of existence. They arranged for space in the hospital, organized the transportation of the village women into Mysore, provided highly qualified social workers and nurses to support the education, registration and screening, and generally made us feel at home. We hope PINCC's relationship with PHRII will continue and become stronger.
I glimpsed the famous Mysore palace from the car. It's indeed quite something. They specially light it up Saturday and Sunday nights, and we plan to see it before we leave on Sunday morning. There are lots of tiny shops, few big buildings, and few modern buildings. There are a lot of slender logs used to hold up buildings under construction. One hopes Mysore is not in an earthquake zone.
We had dinner with a lovely Indian family who are good friends of John and Rhoda. The wife is from Karnataka (the state where Mysore is located) and the husband is from Tamil Nadu. This means they grew up in different cultures, speaking different languages. They had an adorable seven year old daughter who speaks precise English in an adorable way, and a handsome 10 year old son. We ate at a nice hotel. The total cost came to about $56 for all 7 of us. The conversation ranged far and wide.
For those of you who have wondered about all the Indian languages, here's the situation: States were established at the time of independence (1947) based on language groups. There are about 28 states, and at least that many languages, most with numerous dialects. Many of the languages are based on Sanskrit, but no one speaks that any more. It's a little like Latin and romance languages. However, the Indian languages are not necessarily much alike. So someone from Tamil would not necessarily be able to speak to and understand someone from Karnataka or Kerala or Andhra Pradesh (where we are going on Sunday). Think about someone from Oklahoma not being able to understand someone from Texas. Even the written languages are different province to province. The national language is Hindi, and now everyone has to take it by 5th grade. But most people do not speak Hindi. The only common language is English, but it is spoken fluently by only 5% of the population. Many "English speakers" speak it hardly at all. The only things the provinces seem to have in common are religions and castes. They all have castes, but there can be differences in the strata from area to area. Generally people marry within only a few levels of their own caste, which tends to perpetuate the system regardless of what the government does, e.g., teaching non-discrimination in schools, caste quotas in government jobs and in the legislature.
Day 3 - Mysore
Today was the second day in the clinic. Again we saw 44 patients, and did our first LEEP Procedure.
I installed myself in the instrument cleaning room where I spent most of my day timing the instrument sterilization process. This meant I had a lot of down time, so I brought my iPod, which created a bit of a stir among the maintenance woman and the nurses, called sisters. I had them listen to Willie Nelson on my iPod and it was clear this was a new experience for them. The maintenance woman spoke no English. She nevertheless kept trying to communicate with me. Somehow we discovered that we both like chocolate, so she kept smiling and saying "chocolate" to me.
I also became friendly with one of the nurses, who is a Christian. She advised me that in Exodus it says women should wear no adornment, so she, unlike virtually all the other women, wore no jewelry, not even a wedding ring. (Hindu women do not wear wedding rings, but rather gold and black mundulas or necklaces, many of which have gold pendants and are quite beautiful.) She questioned me about my knowledge of the bible and was soon able to conclude I was unenlightened. She is bringing her bible in tomorrow to show me where it forbids adornment. I promised her I'd read it (and I certainly hope she's wrong). She invited me to her home, but then remembered it was being repaired. She gave me her phone number for next time I'm in Mysore. This woman also informed me that the white race had been given all the beauty. I quickly demurred, and pointed out to her all the exquisite women in the clinic, and that she herself had a radiant smile. I may have convinced her. She further believes that Jews are the chosen people. I suggested everyone was equal under god. At any rate, you can see I'm having some interesting conversations.
After dinner we met with one of the Mysore Rotary Clubs to request that it support PINCC. Both PHRII and John and Rhoda's friend from last night facilitated this important meeting. The Rotarians were already amazingly knowledgeable about the cervical cancer problem, described the things they could do for us, and invited us to submit a proposal. The meeting was all we had hoped for and more. I talked afterwards with two of the members. One was a young man who I thought might be the Indian Tom Cruise. He wore a suit, about the first I've seen here. He's an actor and owns an outdoor billboard company. Since joining the Rotary five years ago, he's been providing free advertising space for charitable causes. The other member owns a business that transforms molybdenum into a salt. It turns out that China is the largest producer of molybdenum, which is one of those chemicals you don't know much about but is in everything. The US is second in production. This fellow will be off to China in a couple of months.
Oh, I do need to say that while we were out today they paved the road in front of our hotel, and the local cow was no where to be seen. And the equivalent of Fox news is alive and well on Indian TV.
Saturday, November 27, 2010
Wednesday, October 13, 2010
We landed in Entebbe, Uganda on the 3rd of September 2010. The first thing that struck me was the wonderful aroma of burnt wood all through the city. Our driver gave us a quick lesson in Luganda as he drove us to Kampala. Our hotel in Kampala, The Aponye, was wonderful as it offered both hot water and wireless access, both rare commodities, we later came to realize; it explains Carol's excitement as she was privy to the conditions we were headed for. Kampala had an inherent chaos associated with its organization. Despite the chaos, there wasn't a sense of disarray or anxiety about the citizens of the city; they all seemed to be relaxed. I fit right into this sweet mess. We experienced most of the city, short of taking a boda-boda ride; I even got my cell phone unlocked in the midst of all the drama; Carol was impressed!
Once the "A Team" was gathered (Dr. Kay, Dr. Karen, Carol, Jetaun and I) we headed for Gombe. The ride was bumpy, I was glad I had on comfortable clothes! Gombe offered us the bare minimum; basically a few hours of electricity and tubs of water. It was a real, "welcome to my country" moment (please see Karen for an explanation of that line). Despite the scantiness, the hospital staff were enthused and ready to work. Also, the food was delicious even though it was sometimes hard to see what exactly it was that we were eating due to the darkness of the night; hey, they say, mask one of the senses and the other will sharpen to compensate, bon appetit! There was a beautiful funeral ceremony in the village and we got see some of it as we were leaving.
Next stop: Kayunga. This was an interesting place, a lot happened during our five day stay. The hospital staff was overwhelmed which affected their abilities to devote their full attention and energy to PINCC. Meeting and discussions took place in an effort to fix these issues before PINCC's next visit. We were lucky enough to witness a political gathering, and voting polls. It felt like Kayunga doesn't get many visitors because no where else did I hear "mzungu" uttered more. Mzungu is the southern, central and eastern African term for "person of European descent" Literally translated, it means "white person".
The Katikomu Hotel in Kayunga offered running water, cold showers, great food, and comfortable beds. I think the entire town of Kayunga had but one computer, with dial-up internet service that would lead a person to the brink of madness before it started.
The long ride to Jinja was gorgeous; we left a day early because it was a holiday and the clinic was going to be closed, however Dr. Kay was guilt stricken for leaving and having fun, but our presence there would have served no purpose without a functioning clinic. Jinja was very different from the other cities in Uganda, because there were many tourists visiting the Source of the Nile the city was better accommodated for tourists. We ate at a restaurant which offered cheese cake and brownies for dessert!!! It was like we were in the twilight zone, after such scarce conditions, we were being offered cheese cake!
Enter Fandi! Our host during our stay in Kenya. What a place to stay and what a great host! We didn't want to leave because everything was so wonderful! We spent a few days in Kitale District Hospital, finalizing that site. Dr. Kay donated the equipment, I interviewed the staff and we had a farewell dinner, granted one of the nurses wanted to keep me there to wed her son, but I begged and kindly refused; I must say though, I was quite flattered as mothers-in-law aren't usually supposed to be so kind. We spent a few days in Kapenguria District Hospital in Pokot with Dr. Lydia. It was a brand new site, but it ran so very smoothly. We celebrated Jetaun's birthday, played pop the balloons and ate banana cake, yum, thank you Fandi! Our last night in our guesthouse we watched "Karate Kid" and bid Jetaun and Dr. Karen adieu in the wee hours of the morning and a few hours later Dr. Kay, Carol and I flew to Nairobi.
Like the iron that makes the soil so very red, the women seem to be made of iron exuding extreme strength and resiliency, I was humbled by their capabilities.
What an inspirational trip, what a rewarding experience, what an amazing organization!! I am honored to have had the opportunity to join this group.
Segment B PINCC East Africa Trip, September 4-September 18, 2010
Saturday, September 11, 2010
at how different it was from Kisii, Kenya! In almost every aspect the
two East African countries are completely different; first let?s start
with the pace. Kisii although not at New York speed is a fast paced
city with congested streets, motorcycle taxis that weave in and out of
lanes (sometimes causing accidents), and there is always a constant
clamor of street vendors trying to sell you their merchandise. But
when we approached the small town it was apparent that city life would
be forever left in Kenya by the unpaved, pothole filed dirt road that
led us into the town of Shirati. The drive on the dirt roads seemed
like years due to the constant bumps that our van had to endure, but
also the constant stares that we received from the people.
Finally we made it to the hostel where we would be residing for the
next three days, completely intact but exhausted from spending the
whole day driving in that sweltering van. The hostel was a big change
from Ufanisi Resorts where people wait on you hand and foot. We had
the house all to ourselves which was nice because we wanted peace and
quiet from the loud night life in Kisii, but we soon found out that
would not be the case here either. There was always loud music playing
in the distance, dogs barking, and an annoying clicking sound that was
unrelenting. Sunday I spent it sleeping while the others went to Lake
Victoria and Renee went hiking up the mountain nearby. Finally I got
up and went out to go visit the lake which was absolutely spectacular.
The next day was all work and no play, or should I say a lot of
waiting. The day started out very S L O W?My mother had to give a talk
to the whole hospital staff and for the life of them they could not
get the projector to work. We had to set up the rooms, start
interviewing patients (but really wait for patients to arrive), and
get things in order. By noon only nine patients had been registered, a
huge change in pace from Kisii (it continued at that pace for the rest
of the trip). Cryotherapy was needed to help treat the patents but
there was no gas! So no surgeries could be completed and all we could
do were cervical exams; which is very hard because patients would
probably not receive the care they need if we did not treat them. We
could refer them to a hospital several hours? drive away, but many
patients did or do not have the money to go get the help they need. At
the end of this very short visit, the whole group felt defeated and
even contemplated the fact if we should even come back to the hospital
again. We were all ready to leave and have a change of pace at the
next place and so we did?.
Bukumbi was a suburb of Mwanza (the second largest city in Tanzania
aside from Dar Es Salaam) we were all excited to get to Mwanza and do
some shopping! (It was an all women group besides our amazing drivers
Manuel and Mike) We set out around 11AM for the supposed 4 hour drive,
but of course while in Africa you are supposed to expect the
unexpected! And man were we surprised while driving through the
Serengeti, we came upon a bridge with Baboons!
We kept on driving and there were ZEBRAS and WILDEBEESTS!
see wildebeest in background
AND MORE BABOONS?EATING RAW COTTON!
It was like a free Safari, BUT all the fun came to and end at another
bridge (cue the horror music). There was a huge truck that got a flat
tire in the middle of the narrow bridge, and unfortunately the truck
was way too heavy to push it off to the side of the road so we had to
wait and wait and?.. wait. Cars stopped and waited, people walked
around, and even vendors sold bananas and sugar cane! (I of course did
not get to eat anything because I was fasting) We waited for what
seemed like forever but it was only an hour. Anu and I began to get
antsy and thought that we would not reach Mwanza in time to go
shopping. Anu said to me, ?Soon people are just going to build houses
and create a village on the side of the road!? Finally the truck
received a new tire and we were on our way, but not in time to go
shopping. By the time we got to the city all the shops were closing
and it was even time for me to break my fast. We had dinner at a
surprisingly good Chinese place right on Lake Victoria in Mwanza, and
then we headed for the hospital in Bukumbi at which we were working at
as well as residing.
We got there, settled in, and everyone was very pleased with our
sleeping arrangements (it was quite an improvement from our less than
clean hostel in Shirati). The next day my mother gave another lecture
to the nurses and doctors that we would be training the next two days,
we setup the rooms as usual, and things were underway (way different
from Shirati). We saw close to 25 patients the first day, but again we
could not do any procedures because THERE WAS NO GAS; so all the
patients had to be referred again to the Mwanza hospital nearby.
Aside from the absent gas the nurses and doctors were eager to learn
and apparently liked to read as well because one of the male midwife
nurses (one of many) pleaded with me to let him borrow one of my
summer reading books that I desperately needed to complete. I
eventually gave in and let him borrow the book, and the next morning
he said, ?I love this book; I think you will leave this book with me.?
I had to finish it so I politely and as sorrowfully said no, but by
the end of the day I had finished it and decided to give it to him.
(see book in bottom right corner)
The day was similar to that of which before but sadly my partner in
crime and good friend, Anu and her mother Raji left mid day to go
visit family in Dar Es Salaam. And another person was also gone and
well missed, Monica, who had to leave abruptly for a family emergency,
and we continued to send her our prayers. There was also a huge
atrocity early in the morning?.NO ONE WOKE ME UP?.therefore I slept in
and people forgot that I was still in the house and so they proceeded
to leave and lock me in unknowingly. Finally the group realized that I
was not there and returned for me only to see me trying to break
myself out of the house, with arms dangling outside of the jailhouse
like bars that protected our house from burglars. The day went on and
we found out that at 3 PM it was time to pack up and leave for good
this time; back to America. Later that evening we had our last meal
together and reminisced on what a good and rewarding trip this has been.
(Dr. Kenya, Dr.Mutiso [the wonderful doctor head of Kisii], Me
[Rajaa], Renee, Monica, Carol, Raji, Rashmi, Anu )
YOU ALL WILL BE MISSED!
Posted and written by Rajaa Numan (Sixteen years old)
Thursday, September 2, 2010
Friday, August 27, 2010
Our Team: Kenya, Carol, Monica, Rashmi, Raji, Renee, Rajaa, and Anu
From the get-go, trouble and his pal misfortune stared us in the face. One of our medical bags, which contained important supplies like batteries, gloves, and swabs was missing; probably stuck somewhere in Cairo! But of course, Carol, with her everlasting supply of patience and good will, kept calm, while urging Mike (the driver) to check up on the bag' progress. (Thankfully, on Tuesday morning, we had our bag and all of its sorely missed contents). On Sunday, we left Nairobi in a van, packed tightly with bags, equipment, suitcases, and, lastly, ourselves. And, after this 4 hour drive of picturesque views and varying weather patterns, we arrived in Kisii at the Ufanisi Resort, a place of untold comforts. Now, when you think of Africa, you probably think mosquitoes, dirt, no electricity, no running water...you think that we all must be roughing it big time, reeking of bug spray, going without showers, and what not! The future may or may not hold that in store, but for now, we are enjoying the wonderful Kenyan food, hot water, and wonderful lodging. On the night of August 22nd, I know, many of us slept unsoundly...not because of a lack of comfort, but due to the agonizing anticipation, the excitement, and the uncertainty we were facing. Since this was PINCC's first visit to the area, we were unsure of what was in store for us on our first day.
Kisii level five hospital is used to seeing high risk cases: it didn't get that level five status for nothing. Standing resolutely in the hustle and bustle of kisii life, the hospital is fairly large with several floors and passageways galore. Here, in the Gynecological Clinic, we set up our supplies and the equipment. With 5 rooms for examinations and procedures, the team set to work on the long list of women who always appeared promptly in the morning, forming a line outside the door. The first day, Dr. Kenya and Dr. Rashmi practiced basic examination practices and worked with the nurses and Dr. Mutiso, the resident doc, to develop the skills that would transform these fledglings into lean, mean cervical cancer fighting machines. Though the first day saw very little of the more advanced procedures, the nurses were tested and lectured by Dr. Kenya, who handled the training with a masterful prowess that takes years to cultivate.
The place was hopping with activity as Carol sought to project her expansive calm across the area, Dr Kenya and Dr Rashmi coached the nurses, Raji stood in for whatever job had to be done in the procedure rooms, Renee flitted around like an energetic social butterfly, and Rajaa and I reigned as the Data Entry Queens (you may address us as such!). Almost 100 women were registered that day...and 40 were examined. You can imagine the heartbreak we felt when we had to start turning away some of the women. Judi, who handled registration, near begged us to admit more and more:
"This woman is old...almost ancient. And she walked and walked and she had surgery last week and she is on crutches and her daughter won't ask her husband for the car so he can drive her and she's so so so so so ill! We have to put her first on the list!"
As we worked...we developed a routine. We arrive at 8am. The medical professionals join Dr Kenya for a powerpoint lecture that was delivered to the nurses. And Renee, Rajaa, and I would head to the clinic, where we would set up the registration and data entry station. I have to add, just as a little rant of my own, this data stuff would get so convoluted and well...silly! Every person had a unique PINCC number and a hospital number. Thinking we were these brilliant hotshots, we made the PINCC number the same as the hospital number, so things wouldn't be so random.
Little did we know, that almost all the time, people would be assigned the same hospital number...so Rajaa and I would stomp over to the med students doing the number (hands on
hips, frowns on faces) and demand the mistake be fixed...well maybe that's an exaggeration...Rajaa and I are far too nice :)
Anyways, after working for some time, the 10 o'clock tea arrived. Now this tea...it's a godsend. I'm pretty sure it was the wafting,enchanting scent of the chai that prevented any impatience and squabbles. The sight of this tea sent all the nurses into a sighing frenzy. And as soon as they cleaned the last speculum of their last procedure, they ran to the
tea and circled the canisters like zebras at a watering hole (Like the African wildlife analogy?). Soon, even we started awaiting the arrival of the buttered bread and the red and blue canisters.
On Tuesday, directly after the tea, Dr. Kenya oversaw the first Cryotherapy. Dr Mutiso and the nurses clustered around her (oohing and ahing when necessary) and eagerly watched Dr. Kenya perform the freezing treatment. It would get so crowded during each procedure that Dr Rashmi and Raji would literally be swatting some of the nurses away: "THERE'S ANOTHER PATIENT ON THE OTHER SIDE! YOU CAN'T JUST LEAVE THEM THERE!" I guess this behavior is a testament to their dedication to their profession, and really, these nurses are incredible. In the next post, I'll give you a closer look at some of them.
Thursday was crazy. Crazy, crazy, crazy. Carol says that the week worked out perfectly though. Monday was very slow, almost sluggish, as everyone tried to gain their bearing. Tuesday and Wednesday had few procedures, but there was enough to allow the doctors and nurses to practice. But Thursday, oh Thursday. On Thursday, this super blend team of PINCC and Kisii volunteers and medical staff finished 8 LEEP procedures and 3 CRYOS. Though we only saw 35 patients, almost all the major procedures ended up being on that day. Only the sheer will power
and energy of all present could have made this possible.
Right now, it's Ramadan. And Kenya and Rajaa are fasting. I felt it necessary to add, after that bit about that insane day, how amazing they have been, even without eating during the day!
Today is our last day in Kisii. In the morning, we examined and treated 25 patients...even though today is a holiday. Today, Kenya's constitution is getting a makeover. So now, the president has a term, there are checks and balances...and it's more democratic. It's a happy day for the most part, and people really believe that the passing of this bill will bring more rights for more people. Anyways, while people were in their house watching the proceedings or having little parties around transistor radios in street corners, the PINCC team and the Kisii nurses were hard at work. But, after all, it's not all work and no play. As a sincere thank you, PINCC treated the nurses to a lunch at the Ufanisi resort where we are staying. With enough ugali ( a mushy, corn based, rice-looking lump of stuff, which Carol and I love) and chicken for all, we dined together as one happy, content, successful team.
More about these festivities later! Food calls!
Thursday, August 12, 2010
From John Adams
Greetings all from Puttaparthi, Andhra Pradesh, India
Today we completed our fourth and final day with the Sri Sathya Sai Mobile Hospital -- our third training session here. Dr. Narasimhan wants four or more really outstanding doctors trained to full competence in VIA through LEEP. That way he can have VIA and LEEP (and all the rest) available 12 days every month, in the 12 nodal villages.
Dr. Ruth and Maddy are probably arriving at Bangalore airport about now, and Dr. Rhoda and I have a week to relax and to partake of the other joys available in Puttaparthi.
During the past four days we screened 126 women and found that the degree of pathology is already seeming to be lower after the first two rounds. We carried out two LEEPS and two Cryos and did a slew of biopsys and paps. Thing is, at the SSSMH sites, the mobile hospital has built such trust in the villages it serves that it is easy to get women to return for pap and biopsy readings and so we are using "see & treat" sparingly -- only when the need is obvious.
At our closing village today, Chandrayunipalli, Dr. Narasimhan thanked us profusely and told the whole village and all the volunteer doctors of his commitment to PINCC and his desire to have us do a four day camp every time we are in India to build and build and build an outstanding and highly effective program.
The two camps were tiring but exceptionally rewarding for all of us. We are already plotting our return in December -- when it is likely we will open another site, as well as carrying out #2 with PHRII inMysore and #4 with SSSMH in Andhra.