Tuesday, January 24, 2006

Doctors Without Orders

For the past week, I served as a volunteer (“Assistant Doctor”) at the 32nd annual Shree Bidada Sarvodaya Trust medical and surgical camp in Bidada, Kutch (see www.bidada.org for details). From January 2 to the 22, the camp provided free services to 29,594 patients from the underserved villages of Kutch. This was my first experience of camp medicine, which is a different beast altogether than regular inpatient or outpatient care…the sheer number of patients is astounding, the pathology springs straight from the pages of obscure textbooks, and from somewhere in the sickly swirls of chaos a charitable heart steadily beats.
I was asked to assist in the Child Health Care Project, which seeks to offer basic medical, dental, and vision screening as well as preventive health education to school-age children in the villages surrounding the Bidada medical center. Every morning, I went with a group of professionals and student volunteers who left the main camp in a van and drove to a village school to set up clinic. Feeling a bit rusty on my clinical skills after months of essential denial that I’m in medical school, I alternated between volunteer and doctor, sometimes helping with logistics, and sometimes donning the stethoscope identity. In one day, we would screen anywhere from 200 to 400 kids, and leave them with toothbrushes, toothpaste, multivitamins, and anti-parasite pills. As the van drove away from each school, a crowd of giggling children would run after it to wave bye, and this was often the best part of the day - even if we hadn't been able to treat all of their medical conditions with our limited resources, we had made them smile.

At the main camp, I was housed with the other foreigners in a facility facetiously dubbed The White House. I roomed with Mike, the only white guy that Bidada has apparently ever seen. He was an absolute celebrity among the camp grounds - children, workers, patients, and shopowners all lit up with grins and ran up to give greetings when he walked by. While he shook enough hands to make a politician jealous, I laughed and marveled at the scene - somehow, I don't think if I showed up in a small village in rural Europe, I would have quite the same effect on people. White skin holds a sort of power in the developing world, which may be the history of globalization at work. In any case, Mike handled his status with an easygoing charm that could win over anyone, even those unimpressed by the symbolism of his appearance. He's simply that type of guy.

Being executive director of a nonprofit organization in the bay area, Mike has some grant-writing experience, and this came in handy as our group fumbled through writing a grant proposal to the World Bank for expansion of the Child Health Care Project. From our meetings, it became increasingly clear that medical camps such as these need people from all walks of life - though a dire need always exists for more physicians and medical personnel, a camp also must have people with organizational, financial, and managerial skills to survive. During the first day of the pediatric camp, overwhelming numbers of patients converged on the campus, and without sufficient organization, chaos would have reigned for days. Luckily, Vaibhav, a consultant from North Carolina, provided some needed management outside the building while his wife Shefali performed medical checkups inside. (So for anyone who has the idea that medical camps are only for medically-minded volunteers, please discard that notion and come save us management-illiterate science people from the madness.)

I met many other inspirational people at the camp, and Mike and I agreed this was unexpectedly the most enjoyable part of the experience. Tarak and Sharvari, a couple of young doctors fresh off residency, have inspired me to think of following their lead and taking a(nother) year off to travel the world before starting the long stretch of a career. Tushar and Monty, environmentally-minded Jains from Canada, have me itching to join them on yearly Jain youth camps near Niagara Falls.

I also got to know my cousin Ritu from New York, someone whom I'd only barely spoken to in the past, as our interaction had been limited to sporadic family get-togethers. She joined us for a celebration of my dad's and Shaktimasa's birthdays at Roopamasi's farmhouse near Bidada, where a group of Gujarati poets provided the evening's entertainment (although I could hardly understand the poetry, their style was something to behold - it was the proud spirit of gospel in guju guise).

The week was sprinkled with unique clinical experiences, intriguing conversations, trips to Mandvi beach, and loads of freshly made chikky. I've omitted writing about most of the medical nitty-gritty here, to avoid boring the 95% of people who don't care about that stuff...but if you're interested, send me an email and we can talk more about the differences between practicing medicine in the U.S. and in rural Gujarat. (Briefly, I observed the strange factory-like nature of camp life, where one's "humanistic medicine" values taught in socioeconomically advantaged bubbles are not always applied, and where individualized medicine takes a hit in the name of mass treatment. A paradox lives between the very humanistic charitable approach to medical care and the reality that where funds are scarce, individuals are not given priority over the group. Due to lack of staff, checks and balances are visibly absent, and a trainee's medical decisions are often the last word. This is sometimes scary and sometimes gratifying, because the amount of difference you can make is suddenly truly proportional to the amount of effort you're willing to put in, even as a student. This is the reason for this blog entry's title.)

I'm forcing myself to stop writing, lest I continue philosophizing for another three pages. I'm back in Ahmedabad now, fighting off some strange stomach bug that hitched a ride back with me from the village, and letting the sad realization sink in that I have only three weeks left in India. Time is more valuable than ever, so I'm going to go play cards with my grandmother.

(Explanation of pics: 1. Woman patient from village, 2. Sharvari and Tarak seeing patients at schools, 3. Mobile clinic group in van, 4. Children waving bye to us, 5. Ritu and I at Vijay Vilas Palace in Kutch, where Hum Dil De Chuke Sanam was filmed, 6. Dad and Shaktimasa's royal birthday celebration at farmhouse)

Saturday, January 14, 2006

Fight in the Sky

Birds and clouds cleared the way, leaving a perfect bluescreen for the confetti explosion above. Kites of all colors dotted the sky, hundreds of them, circling and dashing round one another in the annual friendly fight called Uttarayan (literally, “to go north” – it marks the day when the sun goes to the northern hemisphere, denoting the decline of winter and the coming of more colorful days). This kite-flying festival is a treasured holiday in Ahmedabad, and this is the first time I’ve been in India long enough to see it.

Bamboo kites are manufactured in small homes and on street corners for weeks before the festival begins. The kite string is enhanced with crushed glass held together by rice paste, making each string a weapon used to cut other kites out of the sky. The entire city spends the day up on its terraces and rooftops, with plenty of kites, sweets, and music around to keep the energy levels high, as people vie with their neighbors to see whose kites survive longest.
Fingers are taped in an attempt to avoid bleeding cuts. Power lines and trees are laced with the carcasses of disgraced kites, and young boys run with tall bamboo poles to retrieve them as prizes.

In the morning, my parents and I went to a relatives’ terrace, and I began to learn the ways of the kitefighter. I’ve flown kites many times, but steering them for deadly purpose is a different ballgame. The first three times I flew, I was easily embarrassed by veteran flyers who quickly sent my kites to a spinning demise. So I let my dad take the reins, and watched as his childhood skills came back to him in beautiful form…he cut a few competitors from the sky while showing me when to pull the string, when to let loose, and how to keep the kite in control. Feeling like a contender at last, I flew high – so high we could barely keep track of the kite, and I had to rely on the pull of the string rather than eyesight to guide me – and knocked three kites into oblivion before finally being cut loose.

The atmosphere was sunny, breezy, and exhilarating. We snacked on chikki and sucked sweetness from freshly peeled sugarcane. We trash-talked and laughed with neighbors. Whenever a kite was cut, we would hear screams of kaippo chhe!, and join in the hysterical laughter.

In the afternoon, I went to Naranpura, where the terraces are so close together you can jump across them with ease, and you have to watch yourself to avoid being bombed by falling kites or sliced by wayward string. At night I met up with Sachin and we flew tukkals, which are kites that have a trail of candles attached to the string, so that all you see are floating lights in the black sky. To make a tukkal, you first fix candles with melted wax into accordion-like paper cylinders, then tie the cylinders to the kite string and let the whole caboodle fly. What results is a mesmerizing illusion that you are not flying a kite at all, but sending flickering fires up to the stars. Of course, there are always white-kite predators at night waiting to cut your tukkal, so that the candles fall back to earth. (This happened to us…but don’t ask me what became of the fallen flames…we didn’t see any buildings catch fire, so no harm, no foul).

I’m tired and happy, and I’m going to board another train tonight…this time to Kutch, to volunteer at the Bidada medical camp. I’ll be gone for a week, and will post again when I return. In the meantime, thanks for the comments, and if anyone wants anything from India, let me know soon so I can try and get it for you!

Wednesday, January 11, 2006

A Warm Southern Welcome for 2006

The past week and a half has been so incredible, I barely know where to begin. Everything from the best and craziest New Year’s I’ve ever had to the ultimate relaxation of backwaters and massage in Kerala…it will be tough to choose words for the experiences, but since I lost my camera and have no photograph record, words are burdened with the responsibility of preservation. I don’t expect that any of you will actually read the following account, as absurdly long as it will be, so if you haven’t the time I’ll simply tell you the stories when I get back. If you do have a moment, check out www.unclero.com. I was lucky enough to have part of a poem selected in the Poetry 4 Relief contest, held in order to raise funds for earthquake victims in Jammu and Kashmir (the website explains). Now, on to a day-by-day account of my trip to India’s spectacular south.

Dec. 30
My flight arrived in Mumbai at 8:15 am, and my connecting flight to Goa did not leave until the afternoon, so I had plenty of time to people-watch as Europe descended upon the airport terminals. Travelers from afar had come ready to party, some of them trying much too hard to advertise that image, wearing gigantic sunglasses and beach-wear indoors. I met Nirav and Jehan at the airport, and together we boiled in our seats waiting for the airplane to come, trying hard to keep sunny side up when the flight became delayed. Once in Panjim, Goa’s capitol, we joined Viral at The Mandovi Hotel and went to dinner on the riverside. Here, a live “orchestra” belted out rousing renditions of terribly bad songs, the undisputed highlight being “I Am A Disco Dancer,” which quickly became the theme song for our trip.

We jumped in a taxi to Anjuna Beach, where thatched-roof beach shacks lined the shore, offering cozy views of serene sandscapes just beyond the reach of the incoming tide. From afar, the shacks were candles illuminating an otherwise black night, casting tempting glows upon the coconut trees and crashing wave-crests. Inside, each shack managed a slightly different ambience, so that one could easily spend an evening hopping between them, sipping drinks and sinking into trance music. This we did for some time - however, our mood that night was not to find peace, but to find the crazy party scene for which Goa is famous. With the help of the only late-night taxi in sight, we barely avoided being stranded at Anjuna, and moved on to the relative liveliness of Baga Beach.

At Baga, innumerable tourists drank themselves to a dancing delirium on the sand. We wove through them and ended up at Mambo Tito’s nightclub, where in spite of a higher cover charge for single males, groups of guys searched in vain for a short supply of girls. We half danced, half laughed at the scene, and when content left the club in search of a 5 am snack. We found my brother’s college roommate Gaurav instead, and joined him and his crowd at a restaurant that never quite got around to serving us food. As I write this, I’m quickly realizing that most of the stories from the night are better told in person – so next time I see you, remind me to tell you about the security guard that bargained with himself, the guy who tried to beat his girlfriend on the street and was told by a policeman to “keep your problems at home,” and the traffic cop who answered his cell phone and ignored the immediately resulting scooter crash.

Dec 31
We slept in, and emerged by night. Our hired driver Laxman, looking too young to drive in spite of a well-placed mustache, was all smiles as he drove us to Baga to meet Jehan’s Sri Lankan friends for dinner. We ate at a beach shack playing a fabulous reggae-trance version of Dark Side of the Moon, and left defeated when the waiter wouldn’t sell us the CD. Although Baga was bumping, we’d been recommended to Club Paradiso at Anjuna for a good New Year’s party, and so drove to the northern beach where the scene was completely opposite from the night before.

Anjuna was overflowing. To avoid an all-male party, Club Paradiso was denying all single guys at the door; since we were 4 guys and 2 girls, we asked two British tourists (a mother and daughter from London) to join our group. Once inside, we were met by the sweetest New Year’s venue I’ve yet seen. The club boasted 4 outdoor levels, the top one a psychedelic dance jungle, followed by two balcony levels and finally a platform right on the rocky water. Beneath everpresent coconut trees and stars, DJs spun trance and staff members sold glowsticks to the growing crowd. At the end of the midnight countdown, fireworks launched from the club grounds to explode in fiery magnificence directly above our heads, and as blazing streaks spiraled to an oceanic rest, we congratulated ourselves on ringing in the New Year with a bang. Then we danced the night away. I’m not usually a fan of trance music, but something about the beats went under my skin and moved me, until my limbs were simply instruments of the fantastic sounds and their vibrations.

At around 3:30 am, Viral and the two Londoners (by this time big fans of his) convinced the rest of us to leave in search of another beach, to add variety to the night. After stopping our young British friend from lobbing eggs at the beehive of single guys buzzing around the club entrance (she did manage to hit one), we drove to Candolim, where we dipped our feet in the surprisingly warm water and snacked on fresh Goan bread. Rested and ready for more, we (guys only, as the girls all took their leave) searched for another scene. By word of mouth, we learned of the Hilltop Party, hidden in the heights beyond the beaches, and were taken thither by the faithful Laxman.

At Hilltop, we finally witnessed the Goan culture of lore. Goa, the birthplace of trance and resort of drugged-out hippies, showed itself in full form. In the center of a large grassy knoll, pure 160 beat-per-minute Goan trance electrified the partygoers, who formed a skyward mass of undulating, disembodied limbs. The perimeter of the dance area was marked by gigantic purple-green posters made luminescent by the blacklights, and beyond this border lay a rectangle of large mats where a dimly lit drug culture lived and breathed in smoky fumes. We all agreed that our Goa experience was now complete having laid eyes on this scene, and shortly thereafter, we all agreed to leave the insanity.

The sun was now beginning to climb the sky, so we clambered up a nearby golden hill and watched as 2006 took its first daylight breath. 4 of us, friends made closer by an everlasting night, sat mesmerized as the party was slowly overtaken by solar rays. A red-orange sun ascended the coconut trees to claim its place in the heavens. A feeling of hunger pulled us. After a long drive back to the hotel for breakfast, we succumbed to the soothing relief of bedtime at 9 am.

Jan 1
Happy New Year! We slept in again, then hired another driver (this time a shady character, a far cry from the grinning Laxman) to take us to Colva beach. We sat on the beach absorbing our experiences, and gazed at the horizon as our morning’s rising sun took a fall to conclude its reign over the world. After a beach shack dinner, we drove to the train station, where Nirav, Jehan, and I said goodbye to Viral. (Viral was going to Delhi, the rest of us continuing south to Kerala.) I forgot my camera in the car, and when we later called up the shady driver, he denied ever having seen it...thus were lost all the pictures from our New Year’s celebrations.

Jan 2
After a grueling overnight trip in the sleeper car, during which several different people attempted to share Nirav’s bed berth in spite of his objections, we arrived in Kochi and made our way to the Casino Hotel on Willingdon Island. The polite hotel smacked us with the smell of pine-sol. Jehan’s friend Kalyan awaited us, and with this addition our group was once more a foursome. Our tour guide left us no time to shower, and zipped us off to see the sights, including a 16th century synagogue and the Dutch Palace with its beautiful mural portraits of the Ramayana. We learned of the coming of Vasco de Gama, the Portuguese takeover, and their eventual dismissal by the Dutch (all before the advent of British rule). At night, we took in a traditional Kathakali dance performance, beginning with the complex makeup rituals of the male dancers, followed by a demonstration of the gestural language of Kathakali, and finally a truncated performance of Shiva punishing Arjuna for his pride.

Jan 3
In the morning, we visited Fort Cochin and saw the famed Chinese fishing nets, gigantic wooden contraptions which trap flopping silver fish. After seeing St. Xavier’s Church, the original burial place of Vasco de Gama, and a Dutch cemetery, we drove away from city life to soak in the backwaters of Kumarakom.

The Backwater Ripples Hotel, situated amidst the purple water-lilies, herons, and coconut trees, reminded us of the beauty that sunlight can offer when you don’t sleep in all day. We swam in the infinity-style pool that seemed to empty straight into the lake, and took an evening Sunset Cruise for our first experience of Kerala waters.

At night, classical musicians gave a Karnataka music performance in the hotel gardens. Initially, only 3 of us formed the entire audience, making for a beautifully serene and solitary environment to enjoy the mystic violin and percussion melodies. However, the ambient silence was soon smashed by wildchildren. Two women showed up and let loose a herd of kids, who ran amok, dancing on stage and coming threateningly close to touching the musicians’ instruments as they played. The kids yelled and screamed while their mothers sat back and gossiped, paying no attention to the fact that a performance was underway, and that their kids were playing Godzilla. We each tried to give our best reproaching glares, but to no avail.

A digression: throughout my trip in India, I’ve been surprised by the lack of discipline among many of the young children. They run around fancy restaurants and bang the silverware as long as it pleases them, and parents simply don’t do anything about it. When I expressed this observation to my mom, she put me back in my place, because apparently I was more uncontrollable than any of these little amateurs. Still, I imagine that if I’d jumped on stage and started yelling during a classical music performance, she would have punted me from the premises, and rightly so.

Most Indian parents have very severe stories of how their own parents would assert household rules upon them, and as a result I’d grown up with an image that discipline in India is not something to mess around with. But apparently, the new generation of Indian parents has adopted laxity to an astonishing degree. It seems to be part of the larger philosophy of the streets here, which is, simply put, Anything Goes. If you can drive without lanes, do it. If you can bribe a cop and avoid a ticket, do it. Any way you can make a living, go for it, as long as no one stops you. This philosophy is evident in the smallest and the largest of daily phenomena in India, and I feel it is responsible for many good things (lack of road rage in spite of constant near-collisions) as well as bad things (corruption without even a pretense of secrecy). The funny thing is, if you adopt the Anything Goes philosophy, suddenly you’re no longer frustrated by it.

Jan 4
Kerala is famous for many things, among them a traditional style of Ayurvedic massage. At a local massage center in Kumarakom, we decided to go for the General Body Massage plus Herbal Steam Bath package (totaling 850 rupees). A small and surprisingly strong-handed man led me into a room with a massage bed, and after instructing me to remove my clothes, wrapped me in a small cloth thong which was to somehow preserve my dignity. Feeling like a featherweight Sumo wrestler, I lay on the bed and watched as he heated up various oils (mostly coconut) on a fire. The massage consisted of ensuring that every inch of me (excepting thong-protected areas) was doused in enough oil that I had to lie perfectly still to keep from slipping off the bed and hitting the floor. When I stood up and glanced at the mirror, I looked like a walking stick of Amul butter. Then came the steam bath, which meant sitting in a wooden box with only my head sticking out, as the vapor deep-fried my skin. All in all, a relaxing experience.

Soothed by massage, we rented a small thatched-roof boat and set off into the backwaters, full of gorgeous small canals dripping with lush greenery. This was the most picturesque portion of our trip – one could easily feel displaced in history, surrounded by primitive flora and fauna, at peace with an earth discovering itself for the first time. Had a brontosaurus poked its head out from behind a large fern, it would not have struck me as out of place.
Our tiny vessel’s captain proudly pointed out the village of Ayemenem, Arundhati Roy’s hometown, as we passed through its canals. This was an especially surreal moment for me, as her book The God of Small Things recently became my favorite novel. The story is mostly set in Ayemenem, and as we drifted through the village, I imagined we were there in Ammu’s river that swelled with the rains. When small children waved at us and happily ran after our boat, I imagined them to be Estha and Rahel. When I saw a dark-skinned carpenter by the riverbank fashioning a canoe, I imagined him to be Velutha. And when I saw a small hut with a communist symbol decorating the doorway, I knew it had to be Comrade K.N.M. Pillai’s, and I imagined the passing triple-file legion of marching ducks to be quacking party slogans in a Naxalite demonstration.
After a perfectly outlined crimson sunset, night fell on our journey, and legions of bats began to soar overhead as a local temple played its music of worship.

Jan 5
Now that we had seen life in both urban city and backwater village, we headed for the hills. Munnar is known for its high-altitude tea plantations, manicured patches of green from which Kerala picks its choicest tea. On the drive, we stopped by a waterfall and Nirav and I hiked down to its misty foot, thoroughly enjoying what felt like a bit of Yosemite in the midst of India. We refreshed ourselves with fresh pineapple juice from a roadside stand, and proceeded to wind our way up the mountain roads.

After staying at fairly expensive hotels in Kochi and Kumarakom, we opted for a budget stay in Munnar at the Daneyshree. At a local STD booth (for all you med students, that’s a phone booth), I unexpectedly ran into my cousin Runal from northern California! So we had dinner with him and his sister Riddhi that night, and enjoyed the crazy antics that only Runal can bring to the table. First off, he took us to his hotel but forgot which room was his, so he barged into two different rooms (saying “sorry, wrong room!” each time) before finally resorting to yelling for his mom from the lobby. At dinner, he took a bite of paneer tikka and started panting. I asked him what was wrong, and he gasped, “the food…it’s so…expensive!...no, I mean…spicy!” Gotta love the guy. We amused ourselves by listening to him, while Jehan continued to amuse himself by flirting with elderly French couples (he’s a French-born Sri Lankan) and singing “I Am a Disco Dancer.”

Jan 6
Morning renewed us, and we went for a hike in the mist-laden mountains. The tea plantations glowed in the early light, hills that had been clipped and combed, ready for their photo shoot. Patches of proper England in the midst of Indian roughage. Our guide led us through the tea estates, then up into the dense shrubbery above, pointing out all manner of medicinal herbs along the way. We trampled new paths along the mountain, through thorn-protected bamboo, golden and violet wildflowers, around boulders and trees. Every so often we’d catch dramatic glimpses of the countryside below, moments before curtains of fog closed in to shroud us in clouds of white.

The fog occasionally led us astray. Lost in one particularly dense section of the trek, I paused by a bush to wait for a couple of the others who had taken a water-break. When my wandering eyes slowly came to focus, I noticed that the leaves in front of me carried the weight of at least four dozen scurrying spiders. Moving slowly a few steps away, I came to another bush that was home to literally hundreds of them, small white-spotted black marbles with eight spindly legs crawling all over one another to get closer to the human intruder. We noticed we were surrounded by arachnids, and quickly sped away to safer grounds…what we didn’t notice was that in our few moments of hesitation and wonder, several small leeches had leapt into our socks and were feasting on our veins. It started with a small itch. Then someone checked his leg, and noticed a black bloodsucker burrowing into the skin. We all hurriedly pulled up our pant legs and discovered our attackers, then desperately peeled them off with twigs or fingers, leaving bright red wounds to steadily bleed away. Realizing we had to keep our feet in continuous motion to avoid more leeches, we started to hop around like madmen. Once the bloodsuckers were gone, the situation suddenly tickled us, and we all cracked up at our silly adventure. Jehan nicknamed me Dances With Leeches. We sped down the rest of the mountain, a little less blood but a little more alive.

Jan 7
The last day of our disco-dancing group tour, and the fab 4 was forced to split. This sudden end to the fun brought into sharp relief what I had enjoyed most from the travels – not the partying madness or the beautiful scenery, but the company. All the comic moments, inside jokes, and delirious late-night laughter you share with friends. After the many months I’ve spent away from my usual circle, it meant a lot to be able to share these experiences with a good group of guys, especially with Nirav and Viral, who are like brothers to me. It makes me realize how much I miss the company of my own brother, and many others who are back home in the states. I hope you all have had as wonderful a New Year’s experience as I have, and I look forward to seeing you again, whenever that may be.

My next stop was Bangalore, where my dad’s sister and her family live. However, I was still on the waitlist for a berth in the train leaving Kochi, and the conductor wouldn’t let me on. I ended up taking a bus to Coimbatore late at night (a frightening experience, narrowly missing other sleepy buses on tiny bumpy roads) and arriving at its train station at around 3 am. All I remember is a metal detector that made carnival noises and furious flurries of mosquitoes. Finally I escaped by catching a 5 am train to Bangalore.

Jan 8 – 11
Enjoying family time and relaxing. My cousin Punit took me on a one-day tour of Mysore, where we visited many palaces, gardens, and temples, all beautiful in their own way. I’m going to skip writing about all of them, because the best part of the tour was getting to know my cousin – we’re only one month apart in age, and yet I haven’t had contact with him in nearly a decade. It’s amazing to see how like-minded we are, and what similar experiences we’ve had though growing up in different worlds. I could write another 10 blogs based on the discussions we had, but I’ll spare you the agony. If you’ve actually read this far, I admire your persistence, and salute you. Tomorrow I head back to Ahmedabad for two days, where I’ll enjoy the annual kite-flying festival (if you haven’t read The Kite Runner, please do). Best wishes to all of you, and please keep sending emails when you can, though I know I’ve been bad about responding!