Tuesday, December 14, 2010

Great Success and New Directions!

John Adams
14 December 2010

We have had a hugely successful pair of camps and have also just returned from a very wonderful 48 hour trip to Visakhapatnam and back. In the two camps, in Mysore (#2) and Puttaparthi (#4), we screened about 360 women and also had some very important meetings about the future of PINCC-India. We carried out about 8 LEEPS and as many Cryos.

The Vizag Steel Plant in Visakhapatnam is a government run facility that looks exactly like the huge steel plants we used to have in the USA. If you ever wonder where 41,000 steel worker jobs went, we found them. Vizag Steel is a government owned plant that is just huge -- it dominates the region on the edge of the city. On the leeward side of the plant (we are green and clean, our smoke is blown out over the sea) is a 22,500 Acre township where the workers live. It is a completely self contained company town, complete with temples, hospital, shopping etc. What makes this township stand out is the 10s of thousands of trees that they have planted that make the whole area into a forest. There is little traffic or congestion, as most workers bike to work. Very beautiful and very clean.

Rhoda and I (minor role for me) gave two presentations -- one to the general public (of the township) and one to community leaders, and another to senior officials. Rhoda got her picture in this morning's Telegu language local paper. They would dearly love us to come and open up a PINCC VIA training program here -- we aren't sure yet if it will work out, but we certainly enjoyed the hospitality. If it does happen, the local Sai Baba Temple members will provide all the infrastructure support. This morning before going back to the airport, we visited three villages that would be served -- the most primitive we have yet seen, with thatched roofs, and then toured a huge rolling mill where all they do is create rebar for the world -- tons and tons of rebar!

I am currently putting the finishing touches on a proposal for Rotary International in Mysore and in the Bay area. They were very encouraging about supporting our vision of creating a locally operated VIA centre in Mysore by the end of 2013. Once the proposal has been reviewed by all the important eyes, we will get it submitted and see what happens. I am writing it so that it might also be submitted to other agencies.

It was a joy having Deborah Shefler with us for the two camps. We are hoping that her trip with Stephen around south India is proceeding well.

Saturday, December 11, 2010

Day 9 - First village visit with Mobile Hospital

The day started auspiciously with granola on the breakfast buffet. My tolerance for Indian food for breakfast is by now non-existent. As a matter of fact, I am having trouble eating the Indian lunches that are provided in the field. First, it's all vegetarian, even vegan as there is no cheese or eggs. Second, the quality is poor, not like the delicious northern Indian food and dosas we get at home. Third, I can't stand watching the Indians eat with their hands. Particularly disturbing is what they do with the second course of white rice and curd, or yogurt. They swish it around and around with their fingers and then pop a big bundle into their mouths. Just thinking about it makes me slightly sick. To avoid having to see this, I have been eating by myself at lunch. I would like to avoid lunch all together, but everyone is very solicitous of my welfare so it would be rude to take nothing. They pass milky, sugary coffee or tea around twice a day, and I do enjoy that.

Today was our first day seeing patients with the swami's mobile hospital. The mobile hospital travels 12 day/month, visiting 12 villages, which swami designated. They are nodal points for other villages in the areas from which people come, usually in 3-wheel motor rickshaws. These rickshaws are designed to carry 2 or 3 people. I've seen them carry as many as a dozen, with a couple on the roof. Stephen will recall the problem we had in Fes trying to convince one of these drivers to take 4 of us after dinner one night. The mobile hospital staff sees about 67,000 patients/month, providing health care service to about 250,000 people in the villages around Puttaparthi.

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

What's news in India

One of the pleasures of being in India is reading the newspaper.  While they did report the attack on the ghat in Varanasi earlier this week, mostly they report about corruption, which seems to be rampant, well known, and mostly ignored, except by the newspaper.  Here are a few tidbits from the last couple of days I just can't resist sharing with you.  Truly, I am not making this up, and several items are right out of Slumdog Millionaire.
  • 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.  

John Adams re PINCC developments this trip in India

Greetings from 'Parthi in AndhraPradesh

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.

John Adams, Ph.D.

Day 7- Puttaparthi

One thing I forgot to include in Day 4 was Dr. Susshela's belief that there are 500 year old men living in hundreds of caves in the Himalayas praying for good. They help to keep the world on an even keel, or something like that. She has never seen one of these 500 year old people, but she knows they are there, doing their thing.

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

Day 6 - Mysore to Puttaparthi

The drive from Mysore, through Bangalore, to Puttaparthi took about six hours, but that included two stops. The SUV was comfortable, with room for 6. We were five, including the driver (who has died parts of his hair and beard orange, quite handsome) and Dr. Vijaya, the medical director of PHRII, who wanted to come to see the Sai Baba at darshan. We picked her up at her home and were invited inside. This was my first time in an Indian home. She lives there with her husband, also a doctor, her two sons and their wives, and one grandchild, an adorable one-year old girl. This is the Indian custom: when sons marry they bring their wives to live with his parents. One of the sons had an arranged marriage, the other married for love - but only after obtaining parental approval. Dr. Vijaya is open to her sons living separately, but that has not happened. The home did not look very spacious. It was constructed of concrete and not attractive, although there was a lush garden in front. (The monsoon this year was plentiful, so there is lots of green.) The furnishing in the reception room where we were was decidedly non-western. There was a wooden couch and chairs, not really comfy. The main furnishing was display cases with family pictures and personal mementos from trips, awards, etc. You could tell the whole story of this family were you to be talked through these display cases. We were of course served sweet tea and cookies. They give Rhoda a bead necklace that is supposed to deflect heat from the body, and later a moonstone ring. They even gave me a little silver ring with a purple stone. They were in all ways incredibly warm and hospitable.

The highways we were on were excellent - totally unlike what we experienced in the north five years ago. In many areas they were two way, with two lanes in each direction separated by a median. The only delay was in Bangalore. There is no highway bypass so we are tangled up in city traffic for some time. At each stop light (yes, Bangalore has stop lights, which are rare in Mysore) beggars would approach our vehicle, sometimes selling something, sometimes just thrusting their small child at the window. Once a little girl did a hand stand and then a double somersault with a little boy before asking for money.

We took a morning break at a western type cafe where I was able to get coffee without sugar. Usually the tea and coffee comes with whole milk and sugar already in it, which I don't like. They also had sandwiches, something that is increasingly attractive to me, except for the ubiquitous white bread. At this site one can chose between an Indian and western toilet. The Indian toilet is a stand astride the hole sort of thing, hard to get used to.

We ate lunch at an outdoor place with cows browsing in front. Rhoda and John had been here many times. We again had different types of dosas, set, raga, and paper I think, with condiments and chutneys. Dosas are a good choice almost any time. They come in incredible numbers of varieties made of different types of grain and in different shapes and sizes.

I had a chance to read some of the local newspaper. There was an article about the plight of Indian widows, including a 9 year old who had no memory of ever meeting her "husband" yet had been living in poverty on the fringes of society for decades because she was technically a widow. This reminded me of the trilogy of films we saw, Earth, Water and Fire as I recall. One involved this very problem. The paper is full of stories about corruption and scams. So it's well known, yet persists.

We arrived in Puttaparthi around 4 pm. I got installed in my hotel, the Sai Towers. It is fine, but lacks the amenities of the Urban Oasis in Mysore, a true gem. For instance, the wifi supposedly exists, but you have to have a technician set it up for you, whereas it was hassle free in Mysore. (I'm writing this from a wonderful western type cafe called the Hanaman Hillside Cafe, which features free Wifi that works well.) The English language TV stations are unavailable at the hotel, again unlike in Mysore. They claim they can adjust the programming to bring in these stations, but I have asked twice already and it just doesn't seem to be happening. Jeremy and Anna may appreciate my frustration. On the other hand, the breakfast has greater variety, although the variety is mostly dosas with various veggie accompaniments. I had fresh fruit and corn flakes. I've discovered that ordering black coffee with a side of milk is the way to get what I want. There is a nice, quiet shop in the hotel where I bought a silver and "emerald" ring for $22.

Puttapatri is all about the Sai Baba and his ashram. Pictures of the Sai Baba are omnipresent, and I mean omni. It would probably be close to impossible to take a picture here without some image of him being in it. There is the town outside the ashram and the inside of the ashram. Rhoda and John are staying inside, I'm outside. The outside consists of a few streets lined with little shops. There is no Starbucks, don't even think about it. Restaurants are often on the 2d or 3d floors of nondescript buildings. We ate dinner, for instance, in the German Bakery, which is staffed by fetching male Nepalese refugees. There is a Nepalese shop next door with felted wool hats and other products, and tonkas. The food was great. I was able to have lightly sauteed vegetables with hummus and dense German bread, totally satisfying. I had dinner with John, and a nice conversation, as Rhoda was still working on getting Dr. Vijaya into darshan and a room for overnight. They showed up at the restaurant at about 8:30, but since the ashram gates close at 9 pm, they weren't able to eat. After dinner they all went back to the ashram and I walked around the town. The weather is again perfection, even in the evening. There are many pilgrims here, in particular a group of men wearing black and gold outfits, and many women wearing red saris. There are some serious hippies, many of them Russians. The atmosphere is mellow and non-threatening. While there are beggars on the walk ways in front of the shops, the town itself seems relatively prosperous, probably because of all the pilgrims coming through. The shopkeepers are as "inviting" as you'd expect, very much like in Morocco. There are many westerners, but few of them are obviously American. More often they are German or eastern European. There are also Italians and South Americans. I have already made friends with two chatty women from Vancouver, former telephone company employees, who are not devotees of the Sai Baba but nevertheless come here often to hang out, meditate, take treatments and, apparently, be happy. One was formerly an Olympic kayaker. Both have shoulder injuries. They are staying in my hotel. Deborah

Day 5 - Mysore

Our fourth and final day at the clinic again went smoothly. The trainees are doing well. We were able to do one more LEEP procedure, but that was only two for the whole four days. I was much busier cycling the instruments through the sterilization process because we saw 73 patients, quite a few more than on other days. This increase was in part due to several women still in their 20's coming in. Our target group is women older than 30, since the cancer takes years to develop and the signs rarely show up in young women. At any rate, I felt better utilized and that was a good feeling. Dr. Rhoda volunteered that the instrument cycling went well throughout the camp days. The only real hang up was having only two biopsy tools. We seem to have done an especially large number of biopsies. At the end of the day we met with the doctors and director of PHRII to discuss preparation for the next camp when Dr. Rhoda and John return summer 2011.

Sister/nurse Mary brought me a gift of a Gideon New Testament and a couple of booklets of guidance so I can spend at least a half hour each day improving my soul. As with Dr. Susshela, this is an example of how being in India can be a highly spiritual experience if you are open to it. I'm afraid I'm not, but I do respect the sincere beliefs of the devoted, especially if they motivate good works, as seems to be the case with these health care professionals.

I mentioned before how the washer woman kept trying to communicate with me. As I realize now, she was actually begging, asking me for money to feed herself and family. Funny, but it did not at the time occur to me that that was what she was doing, unaccustomed as I am to having workers beg while on duty. I have her a kiss at the end of the day, but that's all she got from me.

In the evening we went to see the Mysore Palace lit up. It is lit for a half hour on Saturday nights, and one hour on Sunday nights. The grounds and gardens are extensive, circumscribed by a high wall. The open entrance changes from time to time, so we were left off by our motor rickshaw two kilometers from the gate open this night. The walk was good after sitting all day. It is impossible to describe what that Palace looks like with every architectural element picked out in lights. It's a bit Disney-like, but dazzling and impressive. This was the first time I'd seen westerners in several days; there were almost none in our neighborhood, and absolutely none at the hospital. I felt somehow different from the regular tourists, probably because I was having special experiences unavailable to the casual traveler. The maharajah build this palace about 100 years ago, using British contractors - you can see how colonialism benefited Great Britain in many ways. I hope Stephen and I will have time to visit the inside, a museum, during our one day in Mysore. There is also a famous shrine on a hilltop just outside town.

We ate dinner in a popular hotel restaurant called the Park Lane. The food was better than average and there was live Indian music. There was also a clean western toilet with toilet paper, quite an oddity and very much welcome.

I must say that I am already getting tired of eating Indian food all the time. It of course varies in quality. For example, I just couldn't eat the lunch at the hospital today. I ate the sweet, but not much else. Dinner was much better in quality, but a little good Thai or Chinese would be welcome. There are Chinese dishes on some of the menus, but I can't imagine they would match my requirements.

I am sorry to be leaving Mysore. It seems like a relatively livable place, without massive crowds or choking traffic. I'm likely also influenced by our embracing reception here and by the warm and lovely people we have met. Deborah

Day 4 - Mysore

Yesterday was the third day of our four day camp. I've got the instrument sterilization routine down pat now.

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.

I had two fascinating conversations during this event. The first was with a mother and daughter whose husband/father is one of the health officials. The mother had a professional job and the daughter was still in high school. This young woman was extraordinary. She spoke English as if she'd lived in England half her life, although her facility was all the result of Indian schooling. She has won several regional contests testing general knowledge, sort of like the kids in the spelling bee documentary. She has incredible poise. She plans to study physics or some other heavy science in college. At the end of the conversation her mom invited me to come visit her home, but alas there will be no time.

The second conversation was with one of the doctor trainees, Dr. Susshela. This woman was already trained in Puttaparthi, so she was able to assist Dr. Rhoda with the training in Mysore. She is devoted to the Sai Baba and volunteers every month at the hospital at the ashram, although she lives in Bangalore, a couple of hours away. She is a lovely woman very much at peace with herself. She explained that all the Hindu gods are aspects of one god, which I've heard before. She believes that the Sai Baba is an avatar of god. While we all have aspects of god in us, god comes through him as through a fire hose. He is 85 years old. Some years after he dies another avatar of god will be born and identified. A main event at the ashram is darshan, when the devoted gather in a covered space and wait for the Sai Baba to come among them. Sometimes he does and sometimes he doesn't, as he is quite frail now. It is very important to see him and be in his presence so that you can feel his spirit. He can perform miracles, many of which involve getting roads, clinics and educational centers built. One should not wear black to darshan because black clothing blocks the spirit. Much of her motivation to service seems to come from her devotion. It was clear that she felt I could benefit by being receptive to the spirit of the Sai Baba. Deborah

Friday, December 3, 2010

India Trip - December 2010 - Days 1-3 - Mysore

This blog is by Deborah Shefler, PINCC Board Member, who is extremely grateful to be included as the volunteer on this trip.

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.

The neighborhood has a mellow and benign feeling. It is the type of place few tourists come to, but they should if they want to learn what it's really like to live in an Indian city. Mysore has a population of about one million. It is a relatively small city for India. The streets were once paved, but you have to watch carefully where you walk. The traffic is chaotic, the trucks have signs saying "honk please," cows walk in the street (but they look well fed, milked and cared for). People gather outdoors at night, in their front yards, at cafes and "tea shops" (seem to be places to smoke), enjoying the mild weather and each other. There are lots of motorcycles and motor bikes but so far the fumes don't bother me. We went to a little neighborhood restaurant for dinner and for $3 I had delicious, moist barbecued chicken with onions, spicy fried cauliflower (one of the best preparations I've ever had), and hot and sour soup. The restaurant only had 2 knives, so one of us had to do without. Everyone here eats with their fingers.

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.

We had another simple dinner at a dosa restaurant near our hotel. I had a "paper" dosa that was about 3.5 feet long and came rolled and held up by 2 plates. It was crispy, somewhat greasy, and positively delicious. I was able to eat less than half of it. It came with 4 condiments. It cost about 80 cents. John and Rhoda had different types of dosas, also delicious and unbelievably cheap. Our waiter entertained us by reciting his work history, which included several years when he worked as a hospital orderly full time plus as a waiter part time. It rained while we were in the restaurant, and, guess what, the power went out. All the shops and restaurants have generators, so the lights came back on quickly.

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.