Goa!

These photographs are from my travels in Goa December 10th - 18th... my final adventure in India! I'm back home in NJ right now, reflecting and adjusting to being back (at least for a few weeks!)... I'll write more soon. Thanks for reading!


Making friends at Anjuna beach... :)


Hanging out at the Saturday night market in Anjuna


I rented a scooter to get around (ok, ok, and for just for fun!)... unfortunately, I didn't have a helmet... or my license!... but nothing a little baksheesh couldn't fix!


Traditionally dressed women selling fruit at Vagator beach


Beautiful!

Shiva carved into the rocks at Vagator beach


A German, American, and a Swede... who needs the UN?


Anjuna beach....


Boogie boarding!!


I absolutely love the beach... what am I doing back in NJ?!

Village Life, In Pictures

Just this once, I think i'll let the photos speak for themselves... enjoy!

Completing The Project

I spent most of the weekend stressed out about my project... I know, I'm in a developing country, and working with NGOs is never easy, but when an individual who's supposed to be helping instead mindlessly undermines my work (and does so on a regular basis), I start to get pretty pissed off! Here's what happened...

Kamlaka is the man from Impact who was put in charge of arranging my training sessions with the women's groups... he doesn't really do anything himself, but rather sends out one of his guys, Suresh, into the field to talk with the Anganwadi workers a day or two before the session is supposed to happen. On several occasions, Kamlaka has lied or otherwise misrepresented circumstances, either magically cancelling my sessions or pretending there was some sort of misunderstanding and not scheduling them to begin with. I've given up on communicating anything verbally - i submit EVERYTHING in memo format (Memo: please call me tomorrow.... Memo: I will not be here on Friday). Yep, it's that ridiculous, but I've accepted that it's just the way things work around here and learned to work with it.

Now, on Friday, I was all set to go; my translator and I were at the guesthouse (we had just finished shopping for the upcoming week), waiting for the car to come as usual. When it was half an hour late, I called the office to see what was going on... and was told that my meeting had been cancelled! Again! This was a shock because even that morning, when I had seen Kamlaka at the office, he didn't mention anything. Long story short - Neelam was in Palghar with some independent contractors who were conducting an information session, and Kamlaka wasn't letting Suresh come with us (did Suresh even need to attend the meeting? That's right - nope). Neelam defended him (poll: is she purposely a jerk, or just comes off that way?). Well, I had definetely had it... it was my final training session, and this was one of many times something similar had happened... not only was it disrespectful of my time, but it made the NGO look terrible to the women. How can we say that we're going to show up and then not even let them know that the session had been cancelled? Most of the women spend their days working in the fields and come back to the village specifically for the meeting... I felt terrible that, once again, we were letting them down. So I did the only thing I could: I called Zelma, Impact's CEO. She had given me her cell phone number at the beginning and told me to call her if there were any problems... well, this certainly qualified! A few hours later, I was getting apologies, and things have been going well since... gee, I wonder what happened...! It's unfortunate that I had to play the power card, but what the hell, sometimes a little muscle goes a long way.

This week is a hectic one... I'm dedicating it to doing follow-up sessions, which is a bit of a logistical nightmare, but so far things have been going relatively smoothly. We're re-visiting villages where I have previously taught, meeting with the women for brief 10 minute sessions to assess how well they retained the information. We're offering them a small gift for coming to the sessions - clothing for their children - so the turnout has been great. I designed a simple 20 point questionnaire that's being administered my Suresh and Hema (my translator); I spend my time supervising, collecting the forms, seeing patients, and doing manicures for the cute little schoolgirls who peer inquisitively through the windows. The results - thus far - have been incredible; On average, women are scoring 17-19 points, regardless of age or literacy. If this pattern continues, I'll have proved that my project really works: you can use illustrations to effectively teach health concepts to illiterate women. Once I have data that definitively proves it, I can publish and present it, knowing that this project can be replicated in similar communities throughout the world. And that's worth all the bad food and mosquitoes India can throw at me ;).


A photo with women from my last first aid training session.


Demonstraing c-spine precautions at the follow-up session.


Women rummage through the gifts... I bought shorts, t-shirts, dresses, toothbrushes, hairbands... $75 bought enough stuff for approxmiately 300 women. Pretty crazy how far money can go here.


Filling out the follow-up questionnaire; women work in pairs and can use the first aid books to help them recall information.


My team: From the left: Udpal (driver), Hema (translator), me, Suresh, and Kamlaka.

On the way to work...

The last few days have been incredibly trying... some of the people at Impact India's Palghar office are so corrupt and/or lazy that they are continuously undermining my work, and it finally came to the point that I contacted Impact's CEO, Zelma, on Friday. I'll definitely post all the details shortly. Until then, though, on a lighter note, here's what I came across on my way to work Thursday...

Yet Another Train Story

More and more, my varied impressions of India have come to be centered around trains. At first, trains were just a means of transportation - hot, dirty, packed, noisy transportation that made me want to stay as far away from railroads as possible. But over time I have come to see that trains are the "arteries" of India in more than just the literal, practical sense; the culture of train travel and the people I have met along the way have taught me more about this country than almost any other experience I've had here. It is on trains that I have learned to adapt to life here, trains that have thrown India's double life in my face, over and over until I grudgingly accepted it; trains that have shown me the kindness of strangers and the occasional, unexpected coldness of friends. Most of all, I have come to see that - as quoted by one friend - India is both "incredibly gorgeous and absolutely horrible" at the same time, and trains have helped me to accept that, even embrace it.

I took the train into Mumbai on Saturday to hang out with Mike... and, as with every rickety ride along the tracks, I learned a great deal. I met a woman - we'll call her Khalifa - a sweet, well-dressed, middle-aged Muslim woman with perfect English and a shiny new camera phone. She was traveling home after visiting her parents and when I first met her, she was nervously chattering on her phone. Her husband was supposed to meet her at the station in Bombay, but because the train was almost an hour late he called to say he was going home and she should just take a cab. She had three huge bags to carry by herself, down from the train and all across the platform. But how could she argue with her husband? She smiled quietly. Khalifa has two daughters, one finishing high school and the other in college. She proudly showed me their photographs and told me that her older daughter was working part-time in a bank. This was an enormous achievement; she wistfully remembered that, years ago, when she finished college, she had also wanted to work in a bank, but her father forbid it - she wasn't allowed to work near men. So instead she got a job as a part-time nursery school teacher while waiting for her parents to arrange her marriage.

She hasn't worked since then; her husband is a successful stock trader and doesn't allow it; he says that having her work outside the house would detract from her household duties and make him look bad in the community. Women are supposed to stay at home, quietly, the unseen and unspoken caretakers that blend into the background in thick layers of long black fabric. She's bored a lot of the time, and lonely because her daughters aren't around... she makes beaded purses by hand and would like to sell them, but is forbidden. She offered me a small bag of sweets; they're cooked at home by village women who sell them on the trains. She had a brilliant idea a few years ago, to help these women set up a company exporting the candies - they're incredibly popular in the Middle East and selling them there could easily double or triple the womens' incomes. But her husband refused. Has she thought about getting a divorce? She has, she says. But how can she divorce him now? She has been married for so many years. I know, I tell her. I can see it in the gentle lines crowding her face, but I do not tell her that.

Life in India is both strange and familiar... I have learned things about people that I never expected. Of course, there's oppression in this patriarchal society... but I never would have expected such deep-seeded suffering from a well-dressed, well-to-do, relatively modern woman. More significant was the resignation that emanated from her... i could feel it, sitting next to her, looking into her eyes and seeing a soft, quiet sorrow. She was kind, educated, and full of fantastic ideas and great business sense. But she is a woman, a Muslim woman in India, and sharing her dreams with a stranger on a train is as far as she'll ever take them. Things are changing, slowly, and yet very much remains the same. The India I have traveled through over miles of train tracks is revealing in its juxtaposed modernity and baffling antiquity... learning to understand that paradox has made my train journeys one of the most valuable things about living in India.

.

Village women preparing to board a train... they will have just a few minutes to push past the crowds and load their bags into the crowded compartments, traveling for hours to sell their goods on the streets in Mumbai.

Sugar cane, vegetables, and pretty much anything else you can imagine is transported on the trains... there's no rest for the weary.

An afternoon nap, and feet.

An imitation "ELLE Paris" bag, filled with vegetables... probably the most poignant example of the two Indias, overlapping in the strangest ways.

Khalifa (in the blue and white salwaar kamis) demonstrates how she makes beaded bags.

Sharing a snack... and a seat :).

Slums stretch for miles outside of Bandra, one of the main train stations in Mumbai.

Thoughts and dreams live and die on India's trains...

EM Conference

I spent the weekend in Chennai at India's 9th annual International Emergency Medicine Conference. I was originally planning to spend the weekend in Pushkar, Rajastan for the camel fair, but decided at the last minute to ask Cornell's medical student executive committee (MSEC) to fund me for the conference (why turn down a free trip?), and when they agreed i booked my ticket. Sitting here at the computer - yet another first aid training session under my belt - i'm absolutely elated. I went expecting a few interesting lectures and maybe some networking - i got that, and so, so much more!

Arriving at Chennai's reasonably modern airport on Thursday afternoon, I expertly avoided the scammers and touts outside and made my way to Sri Ramachandra Medical College in a pre-paid taxi (this is the only way to go to avoid being cheated, but even then you always have to ask to see their official price list. *Everyone* here tries to extract extra cash from you, and a uniform usually only means they're better at it). Sri Ramachandra is located on the outskirts of Chennai in a rather desolate area of the city, but the campus itself is clean and beautiful with paved roads, a leafy garden, and a surprisingly elaborate temple. My accommodations were right on campus, in the student Annex, which, for 150 RS per night, was a pretty good deal. (But, *was* is a key word here... more on that later...). I had dinner with Ashita (who's in Chennai for the year working on some research projects) Thursday night; it was really nice to be able to hang out with someone from home, even if it was only briefly.

Friday morning was hectic, but once I managed to actually find the auditorium where the conference was being held (it's a huge campus), I immediately met some pretty cool people. First off, I met Mike, an emergency medicine resident at Stanford who looked as lost as I was. We hit it off right away, and ended up hanging out the rest of the weekend. He's doing a one month elective in Hyderabad, teaching emergency medicine principles to paramedics, and for the most part has unfortunately been too busy to see much more of India than the medical school. On Saturday night we took a rickshaw to a banquet sponsored by the conference at a ritzy hotel (in my infinite wisdom, i didn't pack anything even slightly dressy and had to go in jeans and flip flops... but, at least i washed my hair, right? :). Mike kept trying to take photos of families precariously perched on motorcycles and street-side vendors cooking puris over leaping flames... i smiled, remembering exactly how shocking everything here feels at first, and also feeling pretty amazed how easy it is to adapt to pretty much any surroundings. Oh, and yes, the dinner was a lot of fun - Indians have a rather, um, unique style of dancing where all the men dance only with each other (and they really get down!) while women sit around looking bored and a little too proper, vaguely mimicking the atmosphere of an underground gay disco (or what i think one would feel like... i mean, i've never been... absolutely not...).

The conference itself was a huge success for me. From the beginning, i met several attendings and even program directors from LIJ and NYU, all of whom were really interested in my work. I had brought along several first aid training manuals precisely for this purpose, and actually seeing what I had designed really impressed them. I also met up with Dr. Carter and Dr. Balsari (Cornell's residency program director and senior resident), as well as a few other residents and attendings from Cornell, who greeted me with "Zina! How nice to see you! We were just talking about your project and what a wonderful job you're doing!". Considering that I was vaguely concerned whether they would even remember my name, this turn of events was fantastic. In between lectures, I chatted with them about abstract submissions, conferences, and writing up my work into a paper; they were really supportive and provided many useful suggestions. So, I'm pretty thrilled, and have definitely returned to Palghar if a new burst of energy and even greater incentive to keep going with my work and not get too homesick!

The only, shall we say, adverse event that occurred while I was in Chennai happened on Saturday afternoon while I was in my room. I had left the window open because it was so hot, and was standing (barefoot) at a nearby table, unfolding my clothes. Suddenly, a giant - GIANT! - hairy rat, black and about the size of a large cat - leaped through the window, landing at most 1 or 2 inches away from my foot. Now, I love animals, and I even love all kinds of rodents, but this... thing... was a monster! I immediately started screaming and running around the room, looking for something to smack it away with. The rat kept running around the table, and at one point actually leaped up onto it and tried grabbing one of my shirts!! After a few minutes it managed to leap back out the window, leaving dirty little paw prints all over the nicest shirt I brought with me (contributing to my way too casual outfit at the dinner). Oh well... from that point on, heat be damned, i kept my window closed :).

That's it for now... I'm back in Palghar now, back to work, but am looking forward to the weekend! I'm going to meet Mike in Mumbai and show him around... how funny is that, ME, an Indian tour guide? Now I just have to decide whether a brief trip on a train would be a worthwhile tourist detour.... :).


Entrance to the emergency department, and an ambulance backing up outside.


Sri Ramachandra's campus. Surprisingly, it was really clean... and green :). (But, yeah, the food was still pretty bad... sigh...)


Poster advertising the conference. Very... orange :).


From the left, Dr. Sperling, myself, Dr. Balsari, and Dr. Carter.


One of many simulation exhibits set up for the conference - it was really cool, but at the same time a little bit strange... many of the "exciting new technologies" presented were certainly new in India, but fairly well established in the US... but, i guess that just fits the general pattern of how things work here.

Trains

This post is written especially for those of you who have, in one way or another, defended India's railway system. "It's not *that* bad...", "In Russia...", "blah blah blah Tagore blah blah blah Bengal...". Yeah, alright, I listened attentively and heard every word. But then I got onto a train and everything you said was muted by the noise, melted in the heat, and crushed by the impossibly large number of dusty, pushy feet balancing briefcases, baskets of fish, and swaying to staticky pop music blaring from ubiquitous cell phones. Antiquated trains in India may be defensible, but no half-decent lawyer would take the case, I can assure you.

On Friday morning, i took the afternoon train to Mumbai... i had overslept and missed the direct train, and wound up having to switch at a station in between, ending up on a local train for the second half of the journey. For some reason I couldn't find the women's compartment; the one compartment that was actually labeled "women only" was filled with men, and due to extra holiday chaos, the mad rush of saris, bangles, and shiny braids only confused me further. As the train was about to pull away, i finally jumped into the nearest compartment, shoved my way in a few feet from the door, and stood crushed between several sweaty men and an elderly lady resigned to holding an enormous basket of shiny dead fish. "It's OK" I told myself... only an hour to go. A few of the nearby men eyed me wearily, and a young guy with shoulder-length greasy hair commented that I should have gone to the ladies' compartment. "Yeah, I tried", I replied, doing my best to carefully balance annoyance with defiance. He shrugged and looked away. I smiled to myself - I did it! I can survive the trains in India, no problem.

It's amazing how things can suddenly take a bad turn. There I was, about half way into the train ride, stuck between several sweaty bodies, holding on to the nearby peeling yellow railing and staring out the "door" watching nameless valleys and villages fly by. And then suddenly I felt a surge of heat wash over me... everything around me moved faster, and then slowed down... bright flashes of light were followed by blurry black shapes floating in front of my eyes, circling me... my knees felt weak, my lips dry, and I couldn't be sure if i was still holding on to the railing or if I had drifted off. I was about to faint. I don't know if it was the heat or the smell or the fact that I hadn't eaten breakfast that morning, but with a slow feeling of dread I realized that in just a few seconds, I would surely be falling, flat onto sickeningly familiar feet and dirty metal ground. I took a breath, but not too deep - I can't fall, I can't pass out. I can't, I can't, I won't! I have to stand, have to hold on. I searched blindly through my bag for an old piece of hard candy lodged at the bottom... i put it in my mouth, tried to bite down, suck some sugar in before my knees gave up. I was holding on, but just barely. I remembered that the man standing next to me spoke English; I tapped him, hard - he turned and I said "I think I'm going to faint". "Where you going?" he asked; I repeated, "I'm going to faint, to pass out." "OK yes" he replied, understanding nothing but nodding assuredly anyway. Damn it. India. Trains. Trains in India. I can't pass out, I can't I can't I can't.

I didn't have a choice... I had to make a decision, fast. My body wasn't going to deal with standing up for very much longer, and anyway at this point I could barely think clearly. I made up my mind. Carefully holding on to the railing, I slid my body down to the floor, sitting flat on the grungy surface, eye level with the lady who was by now also sitting, basket of fish in her lap, sweat and river water drip drip dripping out. I put my head between my knees. Breathe. It's okay. It'll be over soon. Just keep breathing. But not too much!

I eventually stumbled out of the train at Dadar, one station early. I took an overpriced taxi (who's going to bargain at this point?) to Neelam's apartment and collapsed on her couch. A few hours later, I had regained my composure and was ready to tackle the city heat, wade through traffic, and even take the train again. But I learned my lesson about underestimating anything in India. You may think you know, you may think you're in control, and then suddenly the beast breaks free and you find yourself staggering, gasping, falling in an unfamiliar space that is too suddenly becoming commonplace.

I spent the weekend in Mumbai, celebrating Diwali with Neelam. I took the train back to Palghar Saturday night and spent most of Sunday working on various projects with the comfort of a ceiling fan and cold water. Just to make sure that the chaos described above is fully appreciated (or at least as much as possible from the comforts of American living rooms!), I'm trying to upload a video I shot last weekend of the women's compartment in a local train. Please keep in mind that this is only about half as bad as the men's... my upload today was unsuccessful, but I'll try again tomorrow!