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

1 comment:

  1. This post seems to be a bit too derogatory (i.e. how Indians eat with their hands, how Indian women age, and the reasons to wear a sari) to be posted on your organisation's official blog.