Moving on up!

To those of you who think i'm really roughing it, who worry about what i'm eating and where i'm sleeping... consider this: My new apartment has broadband and cable television, and I just finished a delicious meal of fresh garlic naan, vadas, and raita from the restaurant downstairs. So... welcome to the expat NGO life, such as it is.

I spent the weekend in Mumbai with Neelam; we had a wonderful time exploring the city and going for long walks by the shore. Her apartment is in a more affluent part of South Mumbai, so although there were still cows wandering about, they were immaculately groomed and well mannered (just kidding... but really, it's quite a nice area; much more of a 'hey, i'm in a strange European city' feeling than 'wow i'm in national geographic!'). One of the nights, we went to dinner at her friend's house, a professor who had studied philosophy at Brandeis; we spent the evening discussing Popper, Milton, and epistemology over white wine and baked paneer. You know Thomas Friedman was right when an American-educated Indian can quote German philosophers and has a copy of Pushkin's poetry on his bookshelf...

This morning, I drove down to Palghar with Neelam and Zelma Lazarus, Impact India Foundation's CEO. The state of Maharasthra (the most populated in India) is divided into Districts. Each district is then divided into blocks, and each block contains an average of 100-200 villages. The village, called Palghar, is in Palghar block, within the Thane district (see map below; we're located just two hours north of Mumbai). The NGO has given me a great apartment in their building, just a 10 minute motorbike drive away from the office (that's right... i get a scooter!). Maharasthra, once you get out of Mumbai, is really quite rural; since we're right at the end of the monsoon season, the entire area is green and bursting with leafy plants and lively rivers. I'm lucky that my projects, while allowing me to live in the center of town, will also take me quite frequently to the isolated villages scattered amongst the greenery, as well as to local schools and primary health centers. I'm looking forward to exploring, photographing, and of course, more writing...

Map of Maharasthra state; Thane province is on the west coast, just above the "greater Mumbai" region

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This evening, after settling in, I went shopping at the vegetable market... I bought bananas, pears, green peas, and some strange prickly red fruits that I was convinced would be incredible. I also got fitted for a pale green silvar kamees (a modern Indian dress), which, for about $8, will tailor-made and ready for me tomorrow (we're *really* not in New York any more, Toto!) Tonight at midnight i'm going with one of the girls from the NGO, Priyanka, to see the festivities celebrating the birth of Krishna. Everyone's really excited to show the foreigner around... and i'm certainly not saying no :).

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I have to say, for all of the contradictions of India, the problems, dirt, poverty, bizarre traffic patterns... one thing that I have not experienced is disappointment. The people i'm working with are unbelievably kind and accommodating (at the restaurant, Neelam was very assertive about making sure that there were no peppers in anything!); although they have 'less', the hospitality i've seen here is rarely witnessed in the West. The colors of India, too, are even more evident in the villages; beautiful women in bright colored saris walk along the muddy roads as elegantly as debutantes at a ball; they carry baskets on their heads and backs with pride and grace, making my own careful footsteps for clumsy intrusions. Traveling all over the country, from the steep slopes of the Himalayas to the busy cities, and now, to the most rural of places, I have started to get a feel for India, a taste for the life and the culture. I have much to learn, and there are lessons everywhere; between the cows and street vendors, rickshaws and locomotives, India is lurking... you just have to be patient, wait to be welcomed in. It's midnight soon, and I can already hear the crowds outside my window... I don't need another invitation.

Girls just wanna have fun...

Hey everyone!! Thanks so much for keeping up with my blog, and I promise to post a real entry in a bit... but first, here are some more great photos from the HHE trip (and thanks so much to everyone who shared them on facebook!)


At Shingo-La Pass... we made it!


Examining a village woman... it was very strange, she just randomly came
up to me as I was walking to the village shop, wanting me to listen to her heart...


Shopping in Manali (hey, we deserve it!)

Aww... great group shot (but they all had funny accents ;)

After picking peas with the locals, i became known as the "pea lady"... I think

Lindsey was jealous ;)

That's Tazo, or "poo doggie"... I just couldn't keep my hands off of this

furry little guy...

This is way harder than it looks!

Mumbai

My last night in Delhi, the 29th, was spent visiting the Lotus temple in South Delhi... it's the major Baha'i center here, and I have to say, it's even more remarkable than the one in Haifa. Still, the Israeli one was the first, so still quite significant for its' history... quite ironic, considering the Baha'i origins are Iranian... but I suppose that point just illustrates how globalization can, at least sometimes, transcend intolerance.

I traveled from Delhi to Mumbai via a 17 hour, overnight train... not an entirely unique experience, but certainly an Indian one. We passed the most luscious green feilds and yellow plantations with billowing stalks of wheat and corn... we also passed villages that could have passed for refugee camps, carpeted with blue tarps and muddy roadways. I chatted with a man sitting across from me, and between drinking coffee and eating rice with daal, we managed to have some rather interesting conversations. Amongst other things, I learned that a university-educated mechanical engineer whose daughter is a physician can believe that traditional Indian medicine can cure AIDS and cancer... As always, I am subtley reminded that India is indeed an incredible juxtaposition.

Mumbai is quite a city... the shore, shops, and brightly lit skyline are unexpected, quite welcome reminders of home. Neelam met me at the train station; soft spoken, with calm brown eyes and gentle features, she has quickly become my surrogate aunt. She has been my contact for Impact India Foundation, the NGO that I will be working with for the next few months in Maharasthra. The organization works to strengthen government health programs as well as add their own innovative projects; they work primarily in the villages, and I will be working n Thane Province, in Palghar. I will have several projects, amongst them teaching first aid and emergency medicine principles to specially selected 'health monitors' in the schools, which i'm particularly excited about. In these regions, the vast majority of the population is completely uneducated and ignorant to even the most basic health practices; simple topics, such as rehydration and burn care, can be lifesaving. At the same time, I will be working on developing a manual for IIF's diagnostic mobile, and contributing to their plans for the health fair coming up in October. We leave for the village early tomorrow morning, so i've been using the weekend to relax, read books, and shower as often as possible. On a side note, if anyone's looking for a great book, I just finished "A Thousand Splendid Suns"... quite remarkable.

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Healthcare in the Himalayas

Examining patients has an entirely different meaning if you're under a tree, in the mountains, and your patient doesn't understand why you need them to take their shirt off - both because they don't speak your language, and because an evil spirit has caused their pneumonia, not a bacteria. I give a great deal of credit to the translators who worked so diligently by our sides; their translations spanned not only languages, but also cultures and generations. In general, our setup was simple: in groups of 4-5 medical students, we worked with a physician to examine and diagnose patients; once everything was written down on a sheet of paper, the patient would carry their prescription to the 'pharmacy' - a table with scattered bottles and notebooks - and receive their medication.

Most commonly, the diagnoses were simple - patients had chronic osteoarthritis, exacerbated by long hours of manual labor; gastroesophageal reflux, exacerbated by spicy foods, or pterygium and watery eyes, due to working in the sun without sunglasses. Colds, warts, scabies, and headaches were endemic; ear infections and pneumonias, nearly so. Occasionally, we saw some interesting cases - congestive heart failure, orbital cellulitis, NF-1, even a schizophrenic. In the poorer villages, we saw malnutrition, most commonly in the form of iron deficency. In one village, a limp, sickly six month old was brought in; the mother, fifty years old, was unable to produce sufficient milk, and the child was being fed with butter tea - boiled water mixed with yak butter. Oral hygeine was also a problem; although toothpaste was widely available, not everyone used it, and the dentists on our trek performed many extractions.

Every night after clinic, we had a teaching session - lectures on infectious diseases, women's health, pediatric problems. We also discussed the logistics of the clinic, pharmacy, and general issues that had come up during the day. Overall, it was quite an experience, one that i'm sure I will be reflecting on for some time to come.

Below are some photographs of the pathology and our work.

Examining the cutest kid in the world... he just had had scabies

Take a look at the nails... classic sign of iron deciency

A modified dental chair for the cavity-prone... lots of crying from this station!

Taking a break with village women... by their early twenties, some of these

women have already had several children.

Our land cruiser, a god send! Towards the end of the trip, we were able

to utilize it to carry medicines and the occasional exhausted trekker...

Through the looking glass

I'm all packed and about to leave for the New Delhi train station... i'm taking the overnight express train to Mumbai (express is a relative term... it's a 17 hour train, but I guess it's better than going by, say, horse... everything in India is relative...). I wanted to quickly upload a few photographs... it takes a lot of time to upload these (insert vast amounts of technical mumbo jumbo, but in summary: the internet connection works at yak speed, which is just slightly faster than an injured camel on rollerblades...). Here are a few of my favorites, in no particular order.... I promise to post more over the weekend in Mumbai, as well as to write a lengthy post about some of the interesting medical cases we saw... i'm thinking of you all, and please continue to be in touch!



Pahar ganj - this is the, er, neighborhood I speak so highly of
in Delhi, where my first hotel was... you really do have to be there
to smell it, feel it, to really understand the insanity... but hopefully
this provides a little perspective...



At our first clinic, at a small school in Reru...



With village children... everyone in the Himalayas looks
either much younger or much older than their actual ages...

With a Tibetan woman in one of our final villages... (you can see,

I'm getting quite a tan... yes!)

Mess tents doubling as kitchens, living rooms, and clinics...

all at the end of a rainbow :)

Triage, Himalayan style...

Tibetan monastery at the top of the world...

... spirituality spanning the generations...

Home comes, slowly

An overnight, 16 hour bus ride from Manali to Delhi... a four hour drive to Agra... a five hour drive back... that's 3 days on the road (and i use the term "road" very loosely...); 3 days of subsisting on peculiar tomato-flavored potato chips, enormous bottles of cold water, and a dwindling supply of pink toilet paper; 3 days of swerving along cliffs, around cows, and through groups of young men selling key chain Taj Mahals and expired chocolate; 3 days, of, well, India.

We just got back from dinner at a restaurant in Connaught Place... wandering through the heat, the urine-soaked air, the beggars, and, yes, the cows, i had a strange feeling... somehow, coming back from three weeks in the Himalayas, I recognized the insanity of Delhi, and in a strange way, welcomed it. It's not home, far from it... but, on the way to dinner, I found myself feeling strangely at ease navigating the streets and haggling with rickshaw drivers; it seems that, slowly, India is becoming less overwhelming. That being said, we did go to dinner at TGI Friday's... there's nothing like a cold drink and some cheesy nachos to make you feel home again. (I stole the paper place setting... it had a photograph of NYC on it). The dinner was amazing; for a few hours, i felt like I was temporarily transported home... and, when i stepped back outside into the Delhi heat, it wasn't so bad... not so bad, after all.

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There's so much to say about my experience in the Himalayas that it's difficult to know where to begin. So, i've decided to organize my blog entries about the trip into several topics, the first of which i'm calling "Itinerary"...

The premise of the trip was that we would spend approximately three weeks backpacking between remote villages, stopping in each for a day or two to set up medical clinics and treat patients. This particular region of the Himalayas, Zanskar, is mostly populated with Tibetan Buddhist refugees, most of whom fled after China took over Tibet. It's a magnificent region, and due to its remoteness, the villages have retained much of the traditions that the Tibetans have practiced for thousands of years. The people are mainly poor farmers, and due to the harsh geography, 'real' medical care is only available miles away in Leh and Manali, the two relatively major cities flanking the region. Traveling to such care is no small feat - it requires several days of travel by foot or, if they're lucky, on horseback, along narrow roads carved along the sides of steep mountains, and often in extremely hot or cold weather. There are also major social difficulties; how can a mother, no matter how sick, leave her 5 children and field work to go to Manali for a week? The traditional healers and lamas end up being a major source of healthcare, and although many villagers expressed their dissatisfaction with their services, few had any other choice. Clearly, better care is needed... So, HHE created this trek... and so we went...

After flying into Leh, the capital of Ladakh, and spending two days relaxing and acclimatizing, we set off on a two day bus journey, stopping in two villages - Padum and Reru - along the way. At the second village, I got my first taste of medicine in the 3rd world. We set up a clinic at a school, screening all of the children for dental and medical problems, providing antibiotics, vitamins, and de-worming everyone on site (we gave out mebendazole like candy). I was assigned to triage, and by the end of the afternoon, i must have seen about 300 children. Although there were some interesting medical cases, the most important lesson of the day was a new, deep appreciation for my own ignorance. I was astounded by the exam schedule posted on the wall; these kids, in addition to learning Ladakhi, the local language, study Hindi, Urdu, and English! These are three very different languages, with different alphabets and origins... and then there are exams in History, "popular culture", and mathematics! Here we are, in a tiny village in the Himalayas, and 8 year old children are learning about the Roman empire. In Ladakhi!

Another interesting observation, driving along the 'road' between villages... at one point, i saw, in amazement, a wall dividing two orchards growing fruit and thought of that Robert Frost poem, "Mending Wall". Frost writes, "There where it is we do not need the wall: He is all pine and I am apple orchard. My apple trees will never get across And eat the cones under his pines, I tell him..." I shook my head and thought, how sad, even here, they build walls, divide themselves... and then, minutes later, driving right past this wall, realized my foolishness... it wasn't a wall after all, but an irrigation system... a canal with water running through it to irrigate both orchards, not divide them. It was not the Ladakhis who had thought to divide themselves, but I who had assumed that they were like us... for the rest of the trip, I suspended such judgements and realized that, in very important ways, they were nothing like us at all. Thank goodness, for them.

After the two days' drive, we started off on our trek. We hiked an average of 1-2 days between villages, stopping in each for one to two days of clinic. The names of the villages, for the curious, are: Ichar, Cha, Purne, Testa, Kargiakh, Lakhong, Zanskar-Sundo, and Chika. I will go into details about the medical and social aspects of the trip in subsequent posts; here, I would like to talk about the trip itself. The logistics are, still, mind-boggling; there were 32 medical and dental students, dentists, and physicians; 10 kitchen workers and animal handlers, about 30 horses and donkeys, and 1 dog (Tazo, also affectionately known as 'poo dog' for his insatiable appetite for, well, poo). Each day, we would pack up our gear, have everything strapped to the animals, and then hike along narrow trails carved along the sides of the imposing mountains... I'm amazing no one tripped and fell, but how the horses manage to avoid toppling to their doom is another feat entirely...

As I know that my mother and grandmother are reading this, I'll mention the food... it was incredible. On what was essentially a bunch of pots cooked over an apparatus closely resembling a Bunsen burner, the cooks created, amongst various Indian dishes, cake (yes, cake - chocolate cake!), pizza, french fries, omelets, pancakes... let's just say that this wasn't a bare-bones mac and cheese kind of trip. Every morning, at 6am, we had a pot of hot Chai; every afternoon, a snack of chai and cookies, followed by hot soup before dinner. Several nights, we had hot water for bucket showers, and on the especially cold nights, hot water bottles to snuggle with in our sleeping bags. Outward Bound, this was not!

Needless to say, without this, er, logistical support, the trip would have been near impossible. The amazing care we got left us free to acclimatize, see patients, and really enjoy the experience, instead of having to worry about cooking and setting up camp ourselves. I'll reiterate again just how great HHE is, how organized and dedicated; I can't imagine having had a similar experience without them.

One more note before I retire to bad movies and air conditioning... one night, about midway through the trip, we hiked up a mountain to the Phugtal Gompa monastery, a famous masse of buildings encompassing a Buddhist school and supporting buildings. The monks served us chai and traditional bread with yak butter (never eat the yak butter... just say no, really). We came in order to set up a clinic there the following day, and were rewarded with the rare opportunity to spend a night at the monastery... fresh urine scents aside (i think 'urinal' is a national air freshener in India), what an experience! Giving us instructions about where to find our rooms, Andy, the physician trip leader remarked, "be careful walking around at night... down that hallway, if you turn right at the corner, you'll die. So, don't do that." (he was referring to the completely un-guarded cliff edge lining the side of the corridor!). In the morning, we sat in for the monks' morning prayers and were served more chai... I have amazing photographs of tiny little boys, 3 or 4 years old, running around in burgundy robes and orange hats... future spiritual leaders, but just kids, being kids.

After leaving the monastery, our group temporarily acquired a friend... a beautiful black dog nicknamed 'doggie lama' (he left the monastery to follow us after I fed and played with him... i know, i know, but i swear, he was the most spiritual dog i've ever hugged...).

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More to come in future posts, and soon, photographs.... until then, good night... thanks for reading, and please keep writing! I love hearing from all of you, and miss you all very much!

Massage in Manali

Namaste, everyone!

I'm sitting at an internet cafe in Manali, trying to catch my breath... there is so much to say, so much to explain about these past three weeks... and yet, I sincerely doubt that any words can do my experience justice. How can anything I write explain the trill of climbing over an 18,000 foot pass, or the tranquility of having tea with Buddhist monks during their morning prayers? I will write about it all, of course, but please forgive me if I cannot find the language to explain how grateful I am to have had the opportunity to not just travel in Zanskar, but to feel the people and the region from the inside...

I did, of course, also take hundreds of photographs, and i'll be posting some of those in the next few weeks as well, but again, there's no doubt in my mind that my little 35mm lens won't be able to convey the majesty of the Himalayas and the beauty of the people who live there.

In any case, let me just briefly begin by saying that every medical student should go on a medical trek with HHE... the organization, from start to finish, was incredible; the food was amazing (how do they bake pizza - yes, pizza! - on a 16,000 foot peak?!); the medical experience, extraordinary; and, of course, the scenery was enough to make your eyes water in wonder... I have never been to such a majestic place in my life... I can only hope to go back, again and again, in service of the people and my unending awe that such beauty still exists in the world.

Over the next few days, i'll post individual entries about the medicine, the people, and the trek itself, along with my reflections... I apologize for the delay in writing, but I've spent the entire day running errands, buying amazing Tibetan jewellery, and... going for an afternoon at a spa! That's right... a spa, including a facial and eyebrow threading... all in a little town nestled in the Himalayas! Who says I can't be girly once in a while? Besides, my poor blistered feet were begging for a little relief... :).

I have all of you in my thoughts, all the time... I miss everyone and will post again soon...

Final thoughts...

Leh is incredible... we flew in yesturday morning, with the most spectacular view of the himalayas below. Our hotel is unbelievable; it's as though the forest created it... everything is wood, and blends beautifully into the background of the town. The area is so different from Delhi... it's peacefulness resonates everywhere... you can feel the Buddhism all around. The Dali Lama is in town actually, but we have to leave for the villages before we get a chance to see him...

It was starting to pour on our last night in Delhi... today i checked the newspapers and read that several hundred people had died in the flooding in the north... pretty incredible, nature just coming down and deciding who gets to live or die. I don't have many good thoughts about Delhi - I felt it was dirty, congested, cold... everything that's wrong with modern cities, and none of the positives. But to read about death, and death so close you can touch it, wade through it... it's a chilly feeling, one that makes you stop, makes you wonder if perhaps you saw someone on the street, or met someone along the way, who is no longer here. Rain, heavy rain... and then, nothing.

On another note, in my last few minutes with the internet... there's a saying I read somewhere, goes something like, "the further away you are from home, the closer you feel to it". The more I travel, the more people I meet, the more I feel like a New Yorker, like a Jew, like an American... it's funny that years of living in NYC made me feel further from it, but just a few days in a completely different world, and I find myself telling everyone how "amazing" central park is, how great the medical training in the Bronx is... I suppose that when everything is foreign, the things you know become so much more dear.

Well, this is it... tomorrow we set out on a two-day bus trip to our first village clinic in Padum, after which we will be trekking to get to our other clinic sites. If anyone's interested in finding out more about the program i'm doing, I posted a link in a previous blog to the Himalayan Health Exchange. I still can't believe we're going to be treating 1500 patients in just 13 days of clinics!!! I'm going to keep a journal of my experiences, and then post my entires when I get back...

Thank you all for reading this and writing to me often... a short letter from home is like a hot cup of tea in the freezing cold...