Monday, January 10, 2011

Day 13 - Last Village and end of mission

The opening ceremony before the assembled villagers featured an exhortation by swami, via laptop, to not smoke or eat meat.  He spoke, and his words were translated into English, so I got the message, as did all the villagers.  This is part of the public education program sponsored by the mobile hospital.  BTW, I have seen very little smoking in the villages or in Puttaparthi itself.  There was also a special fire ceremony in which John, much to his obvious delight, officiated, with cues from the other doctors.

Dr. Susheela told me that if I ever needed help or wanted something to happen, all I had to do was write a letter to swami.  I could write it on paper or on my hand, and there would be no need to post it.  Swami gets everything you "send" him.  It's up to you, however, to interpret his reaction, connect the dots so to speak.  For example, something will happen, and you will have to realize it is his doing.  She also told me that I was fortunate to be able to come to the ashram because swami does not permit all to come.  Bill Clinton wanted to come but swami would not allow it.  Obviously, I have something going for me that Clinton doesn't.

One of swami's miracles is completion of a $63 million water system bringing treated water to 900,000 people in 700 villages in Andra Pradesh.  The claim is that it was financed without solicitation, which probably means Tata funded it.  Normally projects in India are delayed, never completed, for instance because of changes in the administration, poorly maintained, etc. This one was completed in record time and apparently works.  That may truly be a miracle.  I was told about a separate water project that saved Chennai, a city of 7 million officially and probably much more unofficially, from having to rely on water trucks for delivery.  But this was also explained to me as a desalinization project, and/or as negotiation of a water sharing agreement among several jurisdictions, so it is not clear to me what swami's role was.  But he does seem able to get things done.

A few of the doctors, such as Dr. Susheela, come every month to the mobile clinic, but most are new each month.  The doctors have to be practicing in Andre Pradesh state.  They are also all devotees.  This is a very popular activity, and there is a 3 month waiting list of doctors who want to come.  They all work for free and from the heart, so they seem to be instantly cohesive.  There is a great deal of camaraderie among them, and they love to tell swami stories.  A particularly charming moment was one morning when one of the doctors passed out little sweets to everyone on the bus because it was his birthday.  It is a tradition in this area to give small presents to others on your birthday.  

The last village specializes in pokuri and they make them for the doctors each month.  Some have chilies in them, or other types of vegetables,  They are delicious, and the doctors look forward to them.  

I spoke with one of the doctors in the general surgery clinic.  Much of what they do with the mobile hospital is remove sebaceous cysts, give steroid injections, and set closed fractures.  As I mentioned earlier, procedures requiring general anesthesia, including knee replacements, are referred to the swami's hospitals, including the new super specialty hospital, the one shaped like Om.  Everything is free at these hospitals.  That is supposed to be the case at the government hospitals for the poor, but in fact it often isn't.  For example, the hospital may claim not to have certain medicines so that the patient has to buy them elsewhere.  Or the hospital won't provide certain services.  Also, the service at the government hospitals is poor, with people waiting around for hours.  Apparently none of this happens at the swami's facilities, which are all funded by his trusts.

The ENT doctor I spoke with told me he has two sons and three brothers in the US, in five different cities -- someplace in NJ, Tennessee, St. Louis, D.C., and Greensboro, NC.  He has been to visit all or some of them, and in particular likes Greensboro.  These relatives are all engineers, the brothers mechanical and electrical, the sons in computers.  None of them has any intention of returning to India.  

Our work with the mobile hospital was very rewarding because the trainees have had opportunities to do LEEP procedures and are already improving their skills.  This was a terrific experience, something truly wonderful to see.  The mobile hospital is known about all over, perhaps all over India,  It would be great is similar efforts took place elsewhere.

One last comment before I start the tourist part of my journey.  At dinner the last night flocks of fruit bats, which look to be about the size of sea gulls with wings spread, flew in loose formation over our outdoor cafe.  The show lasted for about a half hour, with what seemed like thousands of bats circling around the town as the sun set.  It looked like special effects in a film.  

The next activity was my overnight train ride to Chennai to meet up with Stephen.  It was uneventful and I was even able to sleep for several hours.  Deborah

Days 10-12 - Villages with Mobile Hospital

Each of these days we visited a different village.  The 12 nodal villages provide services for 96 villages in all.  I saw little of the first village except the school where we held the clinics.  The uniformed children had their lessons that day under trees behind the school buildings.  I spent some time walking around the second village, which surrounded the school so was easy to access.  It was picturesque in a rural way, with women talking together while they drew water at the communal pump, old people sitting in open doorways, women on porches preparing food.  Today's clinic was in a school facility outside the village, which is the more modern way of building schools, but means I saw nothing of the village itself.

Village buildings here tend to be build of concrete as there is little wood available on the Deccan Plateau, which is where we are.  Many have thatched roofs.  Utility poles are concrete and fences tend to be slabs of concrete or stone set upright like a line of tombstones.  Travel is by motor rickshaw and I saw almost no cars.  The schools are bare concrete, drab and in poor condition, but they may have stone floors.  The children sit on long metal benches attached to long metal tables.  The central square usually contains a shrine and is unpaved.  The streets tend to be packed dirt, but there is very little trash around, refreshing for India.  (The trash problem is of course serious and well known.  Even the doctors will toss trash out the window rather than get up to put it in the trash bin.  There needs to be a national campaign.)  The area is richly endowed with communication towers and surprising numbers of people have mobile phones.  Some people may have TVs.  As I've mentioned, both Muslims and Hindus live in these villages, but we have been told that the groups seldom socialize together.  All the children are adorable, full of energy and curiosity, run around all over the place, peek in at the clinic windows, and smile readily.  The little girls are giggly and shy.  While there are some small trees and shrubs, the women's saris provide most of the color in the villages, something else to be said in favor of this mode of dress.  As Rhoda pointed out, you never see the same sari twice.  There are scruffy dogs all over (in Puttaparthi too, along with fruit bats and monkeys) that do not seem to belong to anyone.  You would not want to touch them, but you are advised not to do so because they have fleas and worse.  Curiously, all the dogs look alike.  They are medium sized, trim, beige, with long tails.  Perhaps there is inbreeding going on.  There are occasional sounds of bellowing oxen, wooden ox carts being the chief means of moving goods from place to place.

My job all three days was to keep track of PAP smear slides and biopsies.  This was a step up from washing the equipment.  I would make sure the doctors completed the reports for the pathologist.  Then I would wrap up the slides with proper identification, label the biopsy bottles, and place matching reports and samples into little zip lock bags destined for the pathologist, an amazing man who donates days and evenings to the mobile hospital.  We did a lot of smears and biopsies, so this kept me reasonably busy.  The first day was a little chaotic until we developed a system, which from my perspective involved bothering people until I got what I needed to fill up the little bags.  Dr. Rhoda of course taught the five trainee doctors about VIA, cryo and LEEP.  We did 2 cryos and 2 LEEPS I believe.  We saw many women, but I don't yet have the total.  Sadly, we found one tiny 68 year old woman with cervical cancer, and I was invited to look through the speculum to see what it looks like.  Quite disturbing.  This woman had never been screened.  The insidiousness of the disease is that it is asymptomatic until it's too late, which is why screening is so critical.  We told this woman to go to the hospital, but she is just as likely to go home and die. We also saw a woman with a completely prolapsed uterus, which means it had inverted through the vagina and was hanging down outside her body.  You could push it back in, but it would just fall out again.  This must be very uncomfortable for her, to say the least.  She was of course referred to the hospital too, for reconstructive surgery.  One woman fainted after her procedure, but was ok again within minutes. 

There was a very moving moment on day 11 when a young woman who had had a LEEP procedure come to the clinic to personally thank Dr. Rhoda for saving her life.  She brought her daughter and introduced us to her.  If there is one memory that will epitomize for me the good we are doing, it was this moment, when the young woman took hold of both of Rhoda's hands and wouldn't let go. 

There is some wealth in the villages.  We saw one 22 year old woman who wanted to be examined for infertility.  Her mother brought her in.  She was beautiful and had quite a bit of gold around her neck, and about 10 gold bangles on each wrist.  She definitely stood out.  We had a lunch in the home of the head of one of the villages.  The front of the house was indistinguishable from all the other cracked concrete structures.  A third of the front room was full of sacks of rice to be sold.  There was little furniture or modern conveniences.  There were, however, several rooms, whereas most of the houses look quite small, maybe a room or two. 

I had a chat with the Hyderabad pediatrician on duty and learned that village children do not wear diapers, ever.  Nor are they wiped.  As a result they get frequent urinary track infections.  At least they are not creating landfill problems.  Many kids have mottled teach, perhaps from the excess fluoride I previously referred to.  There is a lot of anemia.

I previously reported that birth control consists of two children followed by tubal ligation.  Of course, it's not that simple.  Mother Theresa, a good Catholic, opposed family planning and was quite influential in India, so that's part of the challenge.  However, there have been inroads in some of the villages.  In her area Muslim men are allowed to have up to four wives.  Each of those wives may have 10 children, for a total of 40.  She saw one 40 year old woman who had 22 kids, and only stopped because her husband died (one wonders why he went first).  Mother in laws have a lot of power, and if she wants her daughter in law to have more children, the woman probably will.  She sees a lot of children with birth defects, not clear why.  It could have to do with consanguinity among marriages in villages. 

Rhoda was asked to address the cervical cancer vaccine several times.  India tried it a few years ago and there were six deaths of women who had been vaccinated.  All of those deaths were for documented reasons other than the vaccine.  Nevertheless, it caused the program to come to a halt.  It will probably be reintroduced, but with better outreach and education. (Reminds me a bit of the uproar in California over smart meters.)  It is not a complete shield, however, so screening will still be necessary.  Also, it won't be of much use to the millions of older women who are the main victims of this disease.  Deborah

Day 8 - Puttaparthi

Rhoda and I spent the morning walking around the area, in part for exercise and in part to see the sights. I can report that yesterday I was the only woman in town wearing jeans, the first day I didn't wear Indian clothing. Puttaparthi has about 8,000 regular residents, about 900 of whom live in the ashram, and a varying floating population. During the recent 10 day celebration of the swami's 85th birthday, there were a total of 1.8 million people here, perhaps 250,000 at one time. Many would have stayed in the concrete warehouses I described yesterday, some of which were built for the occasion.

We visited the old museum of religions that is outside the ashram, as distinguished from the new museum built for Swami's 75th Birthday, which I have not yet seen. The old museum is well done without being glitzy. It is three stories and takes about 45 minutes to walk through. There are dioramas depicting significant aspects of various religions that illiterate people can understand. The individual religious groups come and arrange their own exhibits, which they presumably pay for themselves. There are exhibits about Buddhists, Muslims, Jews, Jains, ancient Greece, Confucians, Christians, of course Hindus, etc., even a little exhibit about Maoris. The message is that devotees of the swami come from all religions and countries and continue to practice their own faiths while following his precepts of doing good and loving. There are models of several temples, including of one of the beautiful wooden Buddhist temples that Stephen and I saw on a previous trip in one of the UNESCO heritage squares in Kathmandu. The main road leading into Puttaparthi is lined with buildings the Sai Baba's trusts have built: a large hospital in the shape (from above) of Om, a music school for traditional music, a separate school for other music, a sports complex including a stadium, a large school for boys, a large school for girls, a graduate school & business college (where John has taught), and a structure for the swami's pet baby elephant. The road is lined with his sayings, in several languages (think Burma Shave). There are no statues of the Sai Baba, but photos are, as I've noted, EVERYWHERE. We walked back to town on a side road that was only recently paved. It runs through a wetlands, or at least land that is now full of little ponds because of the plentiful monsoon this year. This is where the laundry is done. Think industrial level hand washing, drying and ironing. Every morning the laundry is collected from the town. Men carry out huge loads on their heads or on vehicles of some sort. It is washed in concrete vats. It is not clear whether they use soap, and instead of agitation they repeatedly bang the fabric against rocks or the sides of the vats, very hard work. The lines of drying items stretch for perhaps 1/4 mile, row after row. Somehow they are all returned to their rightful owners the next morning, dry and ironed if appropriate. There is of course a separate caste that performs this miracle. I have also heard of the tiffin collectors in Mumbai. Each morning the wife puts her husband's lunch into a stack of metal dishes, which are picked up. Somehow they are delivered hot to the right husbands at work around lunchtime. Another caste performs this miracle. These sorts of labor intensive arrangements, plus having 85 percent of the population involved in agriculture, is how India keeps most of its citizens employed. We visited some American friends of Rhoda and John, Debra and William, who have lived on the ashram full time for 11 years. The have a bit larger room than Rhoda and John are in, but it is still only one room, bath and kitchen. They love living here and don't want to be anywhere else. They are both human resources management consultants, and they are developing a business plan for an on-line values-based product to assess and encourage innovation among all employees of a company, regardless of level. The idea is that everyone can be innovative, they just may approach it in different ways, and if the company understands and properly leverages these talents it can be more innovative generally. They are super enthusiastic about this project, and have already written 300 pages in their business plan. Twice a week they offer western devotees to seminars to discuss the swami's precepts for living. The main event of the day was attending darshan in the evening. I have referred to this before but now I can provide some detail. I went with Rhoda. It is held in a large covered space almost the size of a football field, with crystal chandeliers, a coffered ceiling lined in gold, a marble floor and open sides attached to a spacious performance area up front. Darshan occurs twice a day. Anyone may come, but you are searched thoroughly and can't bring in much other than tissue and money. You leave your shoes outside. Each time about 15,000 people attend. They sit on the floor in designated places. You have to bring a mat or pillow to sit on. There are places designated for VIPs, doctors (up front, which is where we sat), professors, relatives of the swami (he has no offspring or wife, but does have other relatives), etc. There are many westerners in attendance, perhaps 10 percent. A lot of them are older and have clearly "gone native." People are packed in and it is very uncomfortable, at least for me and Rhoda. Men sit on one side and women on the other. There are many security personnel. For the first half hour or so of the ceremony singers perform ancient vedic chants, i.e., pre-Hindu. The sound system is excellent, but I can't tell you if there is instrumental accompaniment because we arrived after that. People come and go. Then they do a couple of hours of bhajans, which are spiritual chants of the call and response type. They are highly rhythmic, and are accompanied by percussion, some sort of baffled keyboard, a flute, and drums. At some point the swami is supposed to be wheeled in and take his seat on a throne in the front with two gold (I'm told real gold) lions by his side. Unfortunately, we left before he came last night. Sometimes he doesn't come, and when he does you never know when. I had been looking forward to this ceremony because I thought I would be able to practice yogic breathing and enter some sort of trance state. However, I only felt uncomfortable.