The training begins!

Today was my 4th day of conducting first aid training sessions in the Adivasi villages. I've gone through 3 translators... the first one didn't speak English (they tried to convince me it would be fine... folks, i really just can't make this stuff up!); the second quit after one day, demanding a much higher salary; the third is a really sweet girl, just out of high school, who is much too shy to be a translator in front of a large audience... but we're making progress. The entire thing, actually, is pretty surreal... each day, we drive in a 4x4 into the most remote places, on impossible winding roads past bathing buffalo, herders, fishermen on ancient wooden boats, women balancing huge baskets of fruit on their heads, and massive, swaying fields of rice and corn. The training sessions take place in a variety of environments, and each day is different; i work in large fields, under palm trees, tiny mud-brick schoolhouses, and on riverbanks. I think that if i had a video crew follow me around for the day, I could easily submit the tape to National Geographic.

The training sessions are going phenomenally well, especially considering all of the obstacles and difficult conditions... an average of 40-50 women have attended each one, except for one enormous session that had 95 participants (and those were only the adults)! Each lesson lasts approximately one hour, including the practical demonstrations. The last lesson is on how to properly deal with trauma, and i have the women come up and demonstrate how they would stop bleeding, observe c-spine precautions (keep the head and neck straight), and properly carry the person. Everyone loves it and we always get a laugh and a lot of applause. One woman that really made an impression on me was this elderly lady at my first session; at the beginning, she barely even wanted to take one of the books, insisting that we was too old and illiterate and couldn't learn anything. But at the end, when we were asking them to repeat what they had learned, she was the best, answering all of the questions correctly! That really made me smile. The villagers are also really sweet to me... today, a few of the men who were watching saw that earlier i had been taking photographs of goats, so after the lesson they offered me a baby goat as a gift! Don't worry, mom, i didn't take this one home with me (besides, he was healthy!), but I did take some great photographs with the little guy.

After the sessions, there's inevitably a long queue of parents wanting to show me their sick or children... generally it's dermatological problems, mainly due to poor hygiene and sanitation... i see a lot of scabies and ringworm, though the other day i did see two cases of impetigo (a bacterial super-infection)! As a result, i started thinking... what else can I do for these people besides teach? So, I came up with the idea of giving each Anganwadi worker (the village lay health assistant) a first aid kit for the village. With Sashi's help, we've put together small kits in bright Tupperware containers with antibiotic cream, bandages, q-tips, Tylenol, anti-diarrheals, iodine, and scissors (and how i got all of this stuff, on such short notice, in my tiny town is really a miracle). Additionally, Impact's mobile clinic is going to start coming with us to conduct hearing and vision screenings after the lessons (as long as we have a captive audience, why not do another health intervention?). So, i'm really thrilled - after all of the hard work and frustrations, i'm really seeing a fantastic result.

Tomorrow is my day off, and i'm going to Mumbai to grab some iced coffee and a Hindi film with the friends I made on the LifeLine Express... in the meantime, enjoy the photographs! :)

Recognizing symptoms of illness in young children

I think we have their attention... at least, their books are turned to the right page... :)

Demonstrating c-spine precautions after trauma (and that's me in a salwaar kamis! I have five of them now)

We teach anywhere... roof? Who needs a roof??

Demonstrating how to make oral re-hydration solution (boiled water, sugar, salt) for treating children who have become dehydrated as a result of prolonged vomiting or diarrhea. I think this is the most important lesson - millions of children in developing countries die from dehydration every year, and if the villagers can remember what i taught, it can save a lot of lives.

This lady was fantastic! Volunteered for everything (this is the page for the trauma lesson)

Practical on how to properly lift an injured patient (rather than just letting them sit or walk around)... we always get a lot of laughs with this one.

That little girl in the yellow shirt is absolutely adorable...

Hanging out with the little ones... see guys, i DO like kids!

With the translator (in pink) and the Anganwadi worker (in the green sari)

Do you think they'd let me have one in New York City? ;)

Life in Palghar (1)

At last... the long-overdue (and repeatedly promised) photographs of my life in India! Just a quick refresher for those of you who haven't been stalking me on the blog (yeah, sure, that's not you... not at all... mmhmm... ;). So, i'm living in a small rural town, Palghar, which is in Maharasthra state, about 2 hours north of Mumbai. For work, I travel out to the Adivasi tribal villages (which give 'rural' a whole new meaning), all of which are located within a 1/2 to 1 hour drive away. So, enjoy! Now that my internet connection is back to the usual yak speed (but it's an athletic yak!), i'll be posting more photographs (and updates on my work) soon!


Cuddling in the rain... even goats need a little loving (but not from you, sicko! ;)


My 'apartment building'... i live on the second floor (and i still don't know what that sign says!)


Shopping at the vegetable market


Mmm... anyone else hungry for some latkes?!


Woman selling fruit on the local train


Celebrating the Ganesha festival in September!


Spectacular beach, about 15 minutes away from Palghar (on motorcycle... whee!)

Just some tribal herders... with umbrellas... wearing dress shoes... nothing to see here, folks, nope... just moving right along...

I think this is one of my favorite photographs; We're wading along the road to an Adivasi village, shortly after another crazy downpour... they don't call it 'monsoon season' for nothing!

Working with Adivasis... we were field testing preliminary sketches for the first aid manual

Women examining the sketches... and how cute is that kid?

All in a day's work!


Fruit carts in Palghar... those little bananas are slightly raw, but surprisingly pretty good!

I gave Moti a bath when I first brought him home... he was a little sleepy afterwards, and not at all pleased with me ;)

Moti on that first night... he was honestly the sweetest dog i've ever met

And what are you looking at?? Walking to work has never been this interesting...

I know, i know, i can't save every puppy... but just look at that furry little guy!! We even have the same hair color :)

Cooking with Priyanka's mother... we're making ladus, a festive dessert (mom, i'm thinking of you here... mmm... sugar... :)

Making the ladus by hand... i think i managed to roll 2 that didn't immediately fall apart... it's hard work!


Moti on the beach... two days before he passed away :(... alright... i'm trying not to think about it... but look how much better he looks than the earlier photos! And look at those big brown eyes... Sigh...

Darjeeling

The 'Toy Train' to Ghoom... yes, it is ironic that it rhymes with 'doom'... ;)

Visiting Darjeeling has been a dream of mine for a long time... it has the fame of Kathmandu, but without all the commercialism and with quite a bit more historical significance... it's the birthplace (and final resting place) of Tenzing Norgay, the famous sherpa who first climbed Mt. Everest with Sir Edmond Hillary (white guys tend to get all the credit, but considering Norgay's inferior equipment and 'assistant' status... he was pretty remarkable). Soham and I visited the Mountaineering and Everest museums where i got to ogle over historic harnesses and carabiners (ok, i'm a climbing geek... but if you're going to be a geek, what better subject is there? Fine, fine, i'm a bit of a geek about lots of things... can we just move on? Thank you :).

On the last day, we made a rather ill-fated trip to a tea plantation... after several hours of walking, getting lost, and then walking some more, we finally got a ride to a plantation whose main tea-processing plant was closed for the season. Nonetheless, we wandered around the tea fields, which are actually steep slopes covered with bushes and the occasional narrow path in between... picturesque, and in the end not at all disappointing, even if i didn't get a chance to brew my own cup. But, I can't let any wonderful experience go without a nagging reality check, can I? A day or two previously, we watched a news report on a local station in which the reporter was interviewing a woman whose husband had died of malnutrition; she was worried that she had nothing to feed her children and hoped she would not die herself... I think we just watched in awed silence - in the midst of such abundant greenery, people are dying from starvation: what is there to say to that? There's lots to scream about, certainly, but to say something - anything - just seemed inadequate. There are such brilliant farming projects and innovations being introduced to modernize subsistence farms around the world (Sach's 'Millennium Project' being the most famous, but there are many others); clearly, we have an incredibly long way to go... forget war-ravaged refugee camps; if farms in the most fertile places aren't producing enough to feed the population (or, alternatively, if too much money is siphoned away from the poor and into deep bureaucratic pockets), then what hope is there for the really desperate places? Medicine is a fantastic calling, but how much can I do if my patients die of malnutrition? Feeding centers, after all, are only a temporary solution... but, I digress. God damn it... I never digress ;). Oh, and yes, I did continue to feed and play with stray dogs... what can I say? I must get it from my grandfather, but I just can't let my furry four-legged friends go by without a friendly hello (and a snack).

In order to get to and from Darjeeling, we had to take a shared taxi (read = 10 people crammed into a 4x4, speeding along cliffs with occasional stops for chai). On the way back, this, um, journey, was particularly hair-raising... Soham was a witness to this, so he can concur that i'm not at all exaggerating... just imagine this: Myself and ten of my newly closest friends are in a shockingly stable Landrover; i'm sitting up front and thus have a spectacular view of the cracked windshield... and pretty much nothing else. We're driving through perhaps the thickest fog i've ever experienced... and we're driving on a narrow (can't emphasize this enough), winding little mud road on the side of a cliff - with no safety fence whatsoever! Every once in a while, we see rapidly approaching headlights and have to negotiate our way around the other vehicle... there are times where i literally lose sight of road on my side, and can only see the endless foggy ravine below... on several occasions, we're forced to swerve around a herd of cows or Buffalo... what could make this even more fun? A rainstorm perhaps? Yep, we got that too. The driver was a real comedian; Soham kept translating his comments, which went something like: "Shit, i can't see anything!" and "Damn, now it's raining... now i really can't see anything!". For once, I could do without the translations! But, you know, finally standing on solid ground, i have to state the obvious: it's pretty tough going back to grocery shopping and television after driving along stormy cliffs in the Himalayas... and you guys wonder about the adrenaline junkie in me ;).

So, overall, the trip was pretty spectacular... the brisk mountain air was a welcome reprieve from the not-so-welcoming grime of Delhi and Mumbai... though, as I was about to find out, those two have nothing - and i mean nothing - on Calcutta in terms of pollution. A certain Bengali friend of mine spent the past week defending Calcutta, trying to convince me that due to the city's claims to cultural superiority, it's also quite picturesque... well, *cough*, Tagore may be a fantastic poet, but let me tell you something: 'City of Joy' isn't a harsh representation of Calcutta - it's downright generous. It's been 3 days since I flew back to Maharasthra, and i'm still coughing up black muck... say what you will about cultural heritage, but Calcutta is pretty freaking far from Paris. However, in honor of Bengal, i'm posting an excerpt from one Tagore's most famous poems, 'GITANJALI' (song offerings):

Mind Without Fear

Where the mind is without fear and the head is held high;

Where knowledge is free;

Where the world has not been broken up

into fragments by narrow domestic walls;

Where words come out from the depth of truth;

Where tireless striving stretches its arms towards perfection;

Where the clear stream of reason

has not lost its way into the dreary desert sand of dead habit;

Where the mind is led forward by thee

into ever-widening thought and action ---

Into that heaven of freedom, my Father, let my country awake!

I'm going to try to post some more photographs in the next few days, primarily of Palghar and the Adivasi villages where i'm working... i finally have a card reader (i left my original USB cable at home, and my spare was stolen by a goat... yes, really...), but please bear with me and remember that internet here is incredibly slow... in the meantime, below are some select images from Darjeeling:

Afternoon break on a terrace with the most fantastic view... not a bad life, eh? :)

Black bears at the Darjeeling animal sanctuary... see, mom, these were the guys that almost ate me and Susan in the Adirondacks... just kidding! They're strictly vegetarian ;).

...because it's there (and i've clearly been reading too many mountaineering books ;).

Hindu temple (aka - monkey temple, because they were everywhere!) in Darjeeling

Sunrise on 'Tiger Hill', overlooking Katchenjunga

At a tea plantation! Spectacular views, and you can already see the fog slowly setting in...



Darjeeling tea plantation...

Swerving around a herd of Buffalo on my favorite cliff-side road...!

Photographs from Nainital

Selected images from Nainital... I promise to post more photographs later! Enjoy!


Sorry fella, you can't ride that bicycle!



Walkway along the water... specatcular fall colors on the trees...



Nainital in the evening, about an hour before sunset...



Another view of Nainital... you can see some of the old British canoes... beautiful!



Hanging out in the trees above Nainital




I gave him my chocolate bar and we sort of made friends...

Canoeing on the Naini Lake (the boys let me do all the work :)

Oasis In The Fall

If there had been an award for the most varied transportation in a 48 hour period, I could have been a contender... traveling from Palghar, to Mumbai, Delhi, Rudrapur, and now Nainital has been accomplished on planes, trains, buses, rickshaws, horse carts, and one very rusty bicycle. Below is a map showing my travel route (in red is what i have already done, and the purple shows the route i will be traveling over the next week and a half):



After leaving Mumbai on October 2nd, I traveled (via a variety of creative - and at times heart-pounding) routes to reach Rudrapur, a small city in the northern state of Uttranchal. Impact India's Lifeline Express (LLE) Train - the world's first mobile surgical hospital - is stationed there, and Impact wanted me to spend several days on the train and in the adjacent clinic and write a report from a medical perspective. So, donning teal green scrubs, I hitched a ride on a remarkably sturdy horse cart and made my way to the train.

The facilities on the LLE train are incredible; not the high-tech you'll find at Cornell, but nonetheless, the train is fully equipped with a large operating theatre where 3 surgeries can be (and usually are) performed at once. The anesthesia machines are brand new, and the surgical equipment is meticulously sterilized by the half a dozen techs running around with tea and syringes. The actual process - from screening to surgery - is very organized; people show up with referrals from Impact's clinics, receive a pre-operative evaluation and medications in the makeshift hospital, and are operated on within 48 hours of arrival. After a short rest in the recovery train car, they are transported by an ambulance (ok, ok, 'ambulance' is used loosely here...) to the hospital for several days of recovery and post-operative medications. The LLE has computers, a lounge, kitchen, screening room, equipment hall... all incredibly impressive for a small train on rusty track in the middle of nowhere... i left in awe... until I got to the hospital.

During my afternoon on the surgical train, I met two great medical interns who were volunteering there for a week. After a few drinks I agreed to accompany them on their overnight shift at the hospital ward where these patients are kept prior to and after their surgeries. Arriving at the ward, the first thing I noticed was that it was not, in fact, a real hospital floor; the 'walls' were half-finished brick enclosures, the 'windows', open, vaguely barricaded gaps. The thin foam pads that passed for mattresses lay close together on the cold stone floor, as thousands of flies decorated nearly every available inch of space. No one had thought to put up mosquito nets... no one considered that the incredibly bright bulbs would attract even more flies and keep patients awake and itching... and, even more incredibly, no one had bothered to even attempt fixing the few fans dotting the ceiling.

As much as the structural problems bothered me, the enormity of the medical and logistical issues was much more concerning. First of all, there was absolutely no facility for emergency resuscitation - no crash cart, no intubation equipment, not even an epipen! The two interns were in charge of the entire ward (around 40 patients and their families), without any physician back-up; the closest doctors are the surgeons, sleeping soundly in a hotel about a 15 minute drive away. On an even more basic level, the IVs were terrible; they were single-valve (as opposed to the double-valve we normally use), which means that blood clots formed regularly in the valves and catheter, requiring patiens to be stuck multiple times, or even worse, leaving them without any venous access at all. While I was there, we had one child who had been vomiting and had swollen cheeks and oropharynx; his IV line was clotted and he wasn't able to drink fluids orally. Everyone agreed that there wasn't much to do except keep him head elevated (ha! with the one pillow??) and administer antibiotics intramuscularly... a rather sorry intervention considering in the US, this kid would be in a well-monitored pediatric bed. I know, i know... this is India... and not just India, but poor, rural India... and, yet, that explanation is just insufficient. As in many of the situations i've encountered, the changes needed aren't massive, expensive projects... they're simple interventions, like mosquito nets in the windows, a few fans, and some decent IVs. If Imapct is going to spend so much time and money providing these surgeries, they should also make sure that the post-operative care is adequate; I will write all of this in my report, and hope for at least a little change.

On a side note... as everyone knows, i'm a major softy when it comes to small, cuddly creatures... babies or animals ;). The hallways were filled with kids' crying, and they all just looked so small and sad lying there on the mats with bandages all over their faces... I had to do something. So, I went on a bit of an adventure in Rudrapur's bazaar... after several hours of wading through junk and mud, I haggled my way to three large bags of baby rattles, toy cars, and stuffed animals. I didn't have enough for every child, but the interns promised to buy additional toys before they left... these kinds of things don't make an enormous difference, but at least for a little while, the hallways resonated with rattling and laughter, and I could leave in peace.

I made my way to Nainital via two buses, a taxi, and a rickshaw... then climbed the steep hill to my little stone motel and went exploring. Nainital is incredible... it's like a little oasis in the north... a giant lake surrounded by trees and mountains, with small, intricately decorated Hindu temples nestled in the woods. The leafy streets are lined with small shops selling thick beaded shawls, spices, colorful bangles and impressive wooden and bamboo handicrafts. There's even a Tibetan market selling imported clothing and decorative statues from Nepal and Bhutan... and, yes, there's tons of great food, pastries, and a coffee shop that has quickly become my favorite place for a mid-afternoon break (what a life!). On my first night, I met a Scottish guy who's traveling through India for a few months... we spent the last two days hiking in the surrounding hills, rowing on the lake, and chatting about books and politics. Today, i'm meeting up with the two interns I was with in Rudrapur, and on Thursday i'm heading back to Delhi... and on to Darjeeling!!

It's been a wonderful week, and I promise to post photographs from the hospital and my travels once i'm back in Palghar... until then, I hope everyone is well... the fall colors here definetly remind me of October at home, so I miss you all!