Saturday, February 27, 2010
Chennai again
We have arrived back in the Chennai area after a couple lovely days in Kerala. I leave tomorrow morning at 4 a.m. for London and then Zambia. We are safe so far! :)
Tuesday, February 23, 2010
leaving...
We leave CMC today to go to Chennai to meet up with Swetha and catch an overnight train to Kerala, where we will be traveling for a couple of days. I'm excited about the overnight train since it's apparently a staple of the Indian travel experience. Hopefully it's a restful staple! :)
In Kerala, we will do a backwater houseboat overnight tour from Thursday to Friday morning. Then we will travel to Kochin and see whatever there is to see there until our overnight train back Friday morning to Saturday morning. We will hang out with Thenu and Nithya's families until my flight at 4 a.m. on Sunday morning to Zambia via Heathrow. Mike, I'll see you in London in a few days!
Some things I've been noticing about south Indian life as I think about leaving:
In Kerala, we will do a backwater houseboat overnight tour from Thursday to Friday morning. Then we will travel to Kochin and see whatever there is to see there until our overnight train back Friday morning to Saturday morning. We will hang out with Thenu and Nithya's families until my flight at 4 a.m. on Sunday morning to Zambia via Heathrow. Mike, I'll see you in London in a few days!
Some things I've been noticing about south Indian life as I think about leaving:
- turmeric on the hands and faces of women in the clinic - apparently it's for married women for good luck
- the different standards for space and touch here - you don't touch when greeting or saying goodbye, although some people will offer me the Western handshake, but you do sit right up next to anyone else on the bus or brush by anyone else without the expected apology in Western culture
- the temperature - it's definitely getting hotter than the warm but comfortable temperatures of our first week or two, and I'm not sure Zambia will be cooler!
- lovely colors and smiles of people in the OPD (outpatient department)
Monday, February 22, 2010
weekend update
I had a fun weekend, so I thought I would update about it, even though I haven't gotten the best pictures from a friend who took them when I didn't have my camera. On Saturday, I joined several other international students in hiking Thode (sp? - pronounced Toad) Hill. It was quite the hike, following spray-painted arrows on rocks and quite steep in some places. But the view from the top was gorgeous. I also have the sunburns to prove that it was sunny and hot! (Forgot to put on sunscreen until half-way through, and by then it was too late. Using doxycycline for malaria prophylaxis doesn't help, I'm sure.)
After the hike, we all guzzled water and relaxed for a bit before going to a local swimming pool (frequented predominantly by Westerners) to hang out. I stayed fully dressed in the shade since my skin didn't need any more sun, but I had fun getting to know some of the other international students, mostly Americans, a little better. In the evening, I read Ravi Zacharias' Walking from East to West (lent to me by an attending here) and relaxed. On Sunday, I went to church in the morning, to the Vellore fort in the afternoon, to chapel in the evening, and to the student fellowship after that.
After the hike, we all guzzled water and relaxed for a bit before going to a local swimming pool (frequented predominantly by Westerners) to hang out. I stayed fully dressed in the shade since my skin didn't need any more sun, but I had fun getting to know some of the other international students, mostly Americans, a little better. In the evening, I read Ravi Zacharias' Walking from East to West (lent to me by an attending here) and relaxed. On Sunday, I went to church in the morning, to the Vellore fort in the afternoon, to chapel in the evening, and to the student fellowship after that.
fellowship
I've had more opportunities to spend time with Indian Christians over the past week or so, which I appreciate. I went to a Bible study at an attending's house last week, went to a local church Sunday morning with an American couple and their baby who are here studying (in addition to going to the college chapel in the evening and singing in the choir again), went to a student group's evening worship and testimony time Sunday night after chapel, and found three other foreign students (one German, two American) besides Nithya and I who are Christians. I learned that Indian Christians call prayer part of "worship" (e.g. "let us worship together now" preceded prayer), and that they sometimes address God as Master (a biblical term but one rarely used in common Western evangelical parlance or prayer).
It sounds like there are many things going on here during the Lenten season, and I am sorry to miss them - talks, extra worship services, liturgy, communion, etc. Church services here are an interesting mix of the liturgy I grew to love during my time attending Anglican communion services in Vancouver, Western praise songs new and old ("There is a Redeemer," "In Christ Alone"), Western traditional hymns, and songs I've never heard before and hope are of Indian Christian origin. So it's been a fun mixture of new, old and familiar, and old yet changed in some way (e.g. new words to a familiar tune). I am grateful it's the same God we worship no matter the place, language, or culture.
view of the chapel and the pond in the middle of the garden in front of it
another view of the chapel
It sounds like there are many things going on here during the Lenten season, and I am sorry to miss them - talks, extra worship services, liturgy, communion, etc. Church services here are an interesting mix of the liturgy I grew to love during my time attending Anglican communion services in Vancouver, Western praise songs new and old ("There is a Redeemer," "In Christ Alone"), Western traditional hymns, and songs I've never heard before and hope are of Indian Christian origin. So it's been a fun mixture of new, old and familiar, and old yet changed in some way (e.g. new words to a familiar tune). I am grateful it's the same God we worship no matter the place, language, or culture.
patient snapshots
I wanted to share a couple of patient stories that have particularly struck/moved me in my time here so far.
The first patient made me cry. A mother and her parents had brought in an 8-month-old baby girl with jaundice. Through the grandfather's explanation and a few questions to my resident, I figured out that she had been brought in six or seven months earlier for jaundice, found to have biliary atresia, and undergone a Kasai procedure to allow the bile to drain from her liver. This had since failed and since liver transplantation was not an option, the goals of care at this point were palliative at best.
The grandfather told me that the itching (from hyperbilirubinemia - high bilirubin levels in the blood) was keeping her up at night crying. Her bilirubin had gone from 17 at the last visit to 19 and her alk phos from already elevated in the 100s to high 200s (a sign of obstruction). Upon reiteration of the no-more-options place we had reached in treatment, tears welled up in the mother's eyes. The grandmother took the crying, fitful baby and walked away, wiping her own eyes. I patted the mother's shoulder helplessly and found a tissue in my purse to offer. Eventually we led the patient's family to an empty room to allow them to talk and cry, and I left the room crying myself.
A second patient that moved me was a child I saw during my time on pediatrics when I went to ID clinic where they see HIV-positive patients. I am sure I will see many more HIV-positive patients and AIDS patients in zambia, but I haven't seen any others here. It was my first time seeing pediatric HIV patients, many of whom were infected in utero by moms who found out they were positive when tested during pregnancy. Seeing one family come in - mother, father, and five-year-old daughter - all HIV-positive felt like such a death sentence. There are not many antiretroviral regimens available here, and compliance is often a problem due to finance, leading to the possibility of resistance.
The first patient made me cry. A mother and her parents had brought in an 8-month-old baby girl with jaundice. Through the grandfather's explanation and a few questions to my resident, I figured out that she had been brought in six or seven months earlier for jaundice, found to have biliary atresia, and undergone a Kasai procedure to allow the bile to drain from her liver. This had since failed and since liver transplantation was not an option, the goals of care at this point were palliative at best.
The grandfather told me that the itching (from hyperbilirubinemia - high bilirubin levels in the blood) was keeping her up at night crying. Her bilirubin had gone from 17 at the last visit to 19 and her alk phos from already elevated in the 100s to high 200s (a sign of obstruction). Upon reiteration of the no-more-options place we had reached in treatment, tears welled up in the mother's eyes. The grandmother took the crying, fitful baby and walked away, wiping her own eyes. I patted the mother's shoulder helplessly and found a tissue in my purse to offer. Eventually we led the patient's family to an empty room to allow them to talk and cry, and I left the room crying myself.
A second patient that moved me was a child I saw during my time on pediatrics when I went to ID clinic where they see HIV-positive patients. I am sure I will see many more HIV-positive patients and AIDS patients in zambia, but I haven't seen any others here. It was my first time seeing pediatric HIV patients, many of whom were infected in utero by moms who found out they were positive when tested during pregnancy. Seeing one family come in - mother, father, and five-year-old daughter - all HIV-positive felt like such a death sentence. There are not many antiretroviral regimens available here, and compliance is often a problem due to finance, leading to the possibility of resistance.
Yet at the same time I was moved with a small portion of God's love for them in the midst of their difficult life circumstances. Jesus loves you, little one, was all I could think with regards to the little girl. Jesus loves you, I thought to the parents who didn't have any easy answers.
And neither do I. But I do have a deep conviction that God walks with them - and with the family of the baby with jaundice - in their situation in love as much as he moves in my privileged life with the same love. Left speechless to communicate any of this by my lack of Tamil, I simply prayed that they would come to know the love of the Father who one day will heal all our diseases and wipe away every tear.
Saturday, February 20, 2010
update 3
I've spent the last week and will spend next week's three days of work at the Low-Cost Effective Care Unit (LCECU). It is a primary care office/small hospital run by family medicine doctors who are committed to serve the poor people of Vellore who could not afford to go to the main hospital of Christian Medical College (CMC). They do some minor procedures as well - toe amputations, pleurocentesis, wound debridement, lymph node biopsy, etc.
I spoke with one of the attendings early in the week about my desire to do medical mission work, and he explained that working here was much like that for him since he speaks another primary language (he's from a neighboring state) and in many ways this is cross-cultural for him. He said that there are many benefits to working with the poor, however: you never feel like you have to up your standard of living to match that of your patients. They are generally very grateful for help. You have the personal satisfaction of doing something good. But we agreed together that it would be difficult to do cross-cultural service on a long-term basis without some sense of calling from and sustenance by God.
Specialists also come into LCECU once a week or so (orthopedics, gastroenterology, psychiatry, etc.) to offer their service to patients at a lower cost than at the main hospital. I got to work with the psychiatrist on Friday and saw in the space of a few hours two psychotic patients, three bipolar patients, one woman with panic attacks, two wives of alcoholics who beat them when they are drunk and spend all the money the family has, leaving them starving, a very depressed woman who cried and cried, a schizophrenic, a person with obsessive-compulsive disorder and hypochondriac, anxiety disorder, depression with temporal lobe epilepsy, depression and anxiety with somatization. It was very interesting (imipramine is very common for depression here since it's cheap, and risperidone for agitation or as an antipsychotic) as well as a bit emotionally wearing.
The psychiatrist explained to me that the alcoholics can take a very small dose of an antipsychotic to curb aggressive behavior when they are drunk. One of the wives cannot afford even the subsidized prescription, which costs Rs. 20 (about 45 cents) for a week, so her husband has been beating up everyone in the house. The psychiatrist explained that social services for domestic violence are nearly non-existent here and "Wives are considered part of their husband's household when they marry. Therefore, their families often tell them to live with or die with their husband if they try to return home. And they do," she said. For want of 20 rupees a week to curb aggression when drunk. My heart both cries for justice and mercy and feels unable to grasp these women's circumstances and their lives. "I don't know how these women go on," the psychiatrist commented several times in the afternoon. I don't either.
I spoke with one of the attendings early in the week about my desire to do medical mission work, and he explained that working here was much like that for him since he speaks another primary language (he's from a neighboring state) and in many ways this is cross-cultural for him. He said that there are many benefits to working with the poor, however: you never feel like you have to up your standard of living to match that of your patients. They are generally very grateful for help. You have the personal satisfaction of doing something good. But we agreed together that it would be difficult to do cross-cultural service on a long-term basis without some sense of calling from and sustenance by God.
Specialists also come into LCECU once a week or so (orthopedics, gastroenterology, psychiatry, etc.) to offer their service to patients at a lower cost than at the main hospital. I got to work with the psychiatrist on Friday and saw in the space of a few hours two psychotic patients, three bipolar patients, one woman with panic attacks, two wives of alcoholics who beat them when they are drunk and spend all the money the family has, leaving them starving, a very depressed woman who cried and cried, a schizophrenic, a person with obsessive-compulsive disorder and hypochondriac, anxiety disorder, depression with temporal lobe epilepsy, depression and anxiety with somatization. It was very interesting (imipramine is very common for depression here since it's cheap, and risperidone for agitation or as an antipsychotic) as well as a bit emotionally wearing.
The psychiatrist explained to me that the alcoholics can take a very small dose of an antipsychotic to curb aggressive behavior when they are drunk. One of the wives cannot afford even the subsidized prescription, which costs Rs. 20 (about 45 cents) for a week, so her husband has been beating up everyone in the house. The psychiatrist explained that social services for domestic violence are nearly non-existent here and "Wives are considered part of their husband's household when they marry. Therefore, their families often tell them to live with or die with their husband if they try to return home. And they do," she said. For want of 20 rupees a week to curb aggression when drunk. My heart both cries for justice and mercy and feels unable to grasp these women's circumstances and their lives. "I don't know how these women go on," the psychiatrist commented several times in the afternoon. I don't either.
Friday, February 19, 2010
Lent quote
As I write this, the holy, orthodox, catholic, and apostolic church—that would be the one mystical body of which we are all members, like it or not—is entering the season we call Great Lent. It is in some sense a self-imposed affliction, a deliberate suffering; it is in some sense a death. It is, nonetheless, a death attended by hope, a death that anticipates new life. We feel how it changes us. We are thereby led to a place where the noises, distractions, and false importance of the street—of our dissipated lives—finally "have no access—a place where they have no power."
Similarly, then, in those seasons of our afflictions—those trials in our lives that we do not choose but press through—a stillness, a calm, and a hope become available to us; they are a stillness, a calm, and a hope that must be acquired slowly because, as Father Schmemann says of our joy in Lent, "our fallen nature has lost the ability to accede there naturally."
We are obliged to recover this wisdom slowly, bit by bit. May our afflictions be few, but may we learn not to squander them.
- Scott Cairns, excerpt from The End of Suffering
This article first appeared in 19 Feb 2010 issue of Christianity Today. Used by permission of Christianity Today International, Carol Stream, IL 60188.
Similarly, then, in those seasons of our afflictions—those trials in our lives that we do not choose but press through—a stillness, a calm, and a hope become available to us; they are a stillness, a calm, and a hope that must be acquired slowly because, as Father Schmemann says of our joy in Lent, "our fallen nature has lost the ability to accede there naturally."
We are obliged to recover this wisdom slowly, bit by bit. May our afflictions be few, but may we learn not to squander them.
- Scott Cairns, excerpt from The End of Suffering
This article first appeared in 19 Feb 2010 issue of Christianity Today. Used by permission of Christianity Today International, Carol Stream, IL 60188.
Thursday, February 18, 2010
fasting
Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?
Is it not to share your food with the hungry
and to provide the poor wanderer with shelter—
when you see the naked, to clothe him,
and not to turn away from your own flesh and blood?
Isaiah 58:6-7
These verses were read at the service for Ash Wednesday yesterday here at the college chapel, opening the season of Lent. It is a time of the church year where we reflect on Jesus' sacrifice at the cross, often giving something up as a fast for the 40 days of Lent (excepting Sundays) as a reminder of the cost to Him to love us. The priest yesterday challenged us to fast in ways like this passage from the prophet Isaiah - caring for the poor, giving of our possessions and time in costly ways, inviting the poor into our homes, etc.
The last part of verse seven reminded me of my earlier post on beholding. I was challenged again to consider whether I actually do these things. Have I traveled half-way around the world to explore a calling to serve the poor cross-culturally (and hopefully in some small way to actually serve them) only to continue turning away from people caught in suffering and poverty when it feels like too much, too daunting, too endless of cycles? In what ways do/can I work - now and in the future - to set the oppressed free, to break yokes? Do I share my food with the poor when it is all I have or only when it's my left-overs taken home in a doggy bag? Would I ever take the risk to invite a poor stranger into my home?
How can I do these things in socially responsible, wise ways that yet still require faith in God to do them and so may continue to hold some risk, some cost, to myself? I want to be willing to do something that costs something, want to be willing to do something that costs everything, out of love for God's children because of God's extravagant, unexpected, grace-filled love for me that cost Him everything. So may this Lenten season be a time where I learn more about taking up a fast that is pleasing to God, when the desire to serve the poor extends its roots deep into my heart, and when I in increasing ways give up living for myself and feast more on living for God and for His Kingdom.
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?
Is it not to share your food with the hungry
and to provide the poor wanderer with shelter—
when you see the naked, to clothe him,
and not to turn away from your own flesh and blood?
Isaiah 58:6-7
These verses were read at the service for Ash Wednesday yesterday here at the college chapel, opening the season of Lent. It is a time of the church year where we reflect on Jesus' sacrifice at the cross, often giving something up as a fast for the 40 days of Lent (excepting Sundays) as a reminder of the cost to Him to love us. The priest yesterday challenged us to fast in ways like this passage from the prophet Isaiah - caring for the poor, giving of our possessions and time in costly ways, inviting the poor into our homes, etc.
The last part of verse seven reminded me of my earlier post on beholding. I was challenged again to consider whether I actually do these things. Have I traveled half-way around the world to explore a calling to serve the poor cross-culturally (and hopefully in some small way to actually serve them) only to continue turning away from people caught in suffering and poverty when it feels like too much, too daunting, too endless of cycles? In what ways do/can I work - now and in the future - to set the oppressed free, to break yokes? Do I share my food with the poor when it is all I have or only when it's my left-overs taken home in a doggy bag? Would I ever take the risk to invite a poor stranger into my home?
How can I do these things in socially responsible, wise ways that yet still require faith in God to do them and so may continue to hold some risk, some cost, to myself? I want to be willing to do something that costs something, want to be willing to do something that costs everything, out of love for God's children because of God's extravagant, unexpected, grace-filled love for me that cost Him everything. So may this Lenten season be a time where I learn more about taking up a fast that is pleasing to God, when the desire to serve the poor extends its roots deep into my heart, and when I in increasing ways give up living for myself and feast more on living for God and for His Kingdom.
Tuesday, February 16, 2010
india slideshow 2
These pictures are from my weekend here by myself when I walked the campus and took pictures one morning. Thought you might enjoy seeing some of the natural beauty. The people and colors are also beautiful, but I find it harder to take pictures without asking and lack the vocabulary to ask. So I don't take as many of people...
Saturday, February 13, 2010
hydration
It is quite dusty here. My feet plus dipper water = dirty flip-flops daily at the beginning of my dipper bath. This was one of my first impressions of India. I've taken to rubbing my no-rub contact solution into my contacts every 2-3 days to allow me to see clearly the next day. I've also learned to drink from a water bottle without touching the spout, like I used to do on family camping trips, although I still spill if I'm the first one to drink from a full bottle. I think I'm probably actually better hydrated here than at home, since I drink a full liter bottle (at least) a day plus coffee and tea. Taking doxycycline with a full cup of water daily probably also helps my hydration status. :)
jewelry
One of the interesting things I've learned a bit about since being here is jewelry. Here are the tips:
1. Women almost always wear earrings. They are usually gold, which none (yes, none) of mine are (I don't think I look good in gold, so I never buy it). So I just continue matching my earrings to the color I'm wearing instead of the culture. Yes, Deana, you can laugh at me.
2. Only married women wear toe rings (read about it here - no idea how accurate this is, but it was interesting), and they wear (usually) matching ones on both feet. I had to remove my one I got at Chincoteague probably 8-10 years ago and hadn't removed since to avoid confusing people. I'm pretty sure my second toe on my right foot has an impression still.
3. Women who are married wear a heavier gold necklace. I have yet to distinguish this type of necklace from other gold necklaces commonly worn. I don't wear a gold necklace (or any necklace at all) on a regular basis, so this one has not been an issue.
4. I have never been a bracelet person. However, I could definitely get used to bangles. I wear them every day on my right wrist since I have my watch on the left, whether or not I wear the silver ones I bought for myself or one of a few sets Nithya's aunt lent me. I am getting attached to having slight tinkles happen whenever I move my hands. They sell bangles in shelves of sets of 10 or so thin ones in all different colors or fewer thick ones. Some are glittery, others have inset shiny things.
1. Women almost always wear earrings. They are usually gold, which none (yes, none) of mine are (I don't think I look good in gold, so I never buy it). So I just continue matching my earrings to the color I'm wearing instead of the culture. Yes, Deana, you can laugh at me.
2. Only married women wear toe rings (read about it here - no idea how accurate this is, but it was interesting), and they wear (usually) matching ones on both feet. I had to remove my one I got at Chincoteague probably 8-10 years ago and hadn't removed since to avoid confusing people. I'm pretty sure my second toe on my right foot has an impression still.
3. Women who are married wear a heavier gold necklace. I have yet to distinguish this type of necklace from other gold necklaces commonly worn. I don't wear a gold necklace (or any necklace at all) on a regular basis, so this one has not been an issue.
4. I have never been a bracelet person. However, I could definitely get used to bangles. I wear them every day on my right wrist since I have my watch on the left, whether or not I wear the silver ones I bought for myself or one of a few sets Nithya's aunt lent me. I am getting attached to having slight tinkles happen whenever I move my hands. They sell bangles in shelves of sets of 10 or so thin ones in all different colors or fewer thick ones. Some are glittery, others have inset shiny things.
convenience
I am reminded - not unexpectedly - by being here of how convenient life is at home. Interactions take place in my first language. In my apartment in Philadelphia, I have water that is always running (well, almost always - when they're not fixing the pipes) and electricity that has yet to go out, requiring a generator (except for that one time when I think we blew a fuse or something). I have internet access that usually works and takes place in my very own living room. My computer turns on without problems or requirement of a converter. I eat in my own apartment meals cooked on my own stove and served at the time I feel like eating. I know where the grocery store is. I do not have to wait in line for a cup of coffee in the morning. I do not have to wait for the bus that comes at hourly or more intervals in order to get home from work. I can get new books to read at the library. I do not put on mosquito repellent morning and evening. I can call my family or friends immediately on the cell phone.
These are small things, but they do add up to small stresses throughout the day. It is an expected part of being in a new country and culture. It reminds me not to take for granted when things happen as expected (the bus comes, and on time) here or at home. It reminds me not to be spoiled by expecting things (particular events, my plans, etc.) to happen when and how I would prefer. Things are actually outside of my control - many things, and not just the ones I have noticed. It reminds me to be grateful for the One who holds all things together, sustaining Creation and our bodies, causing the sun to rise and the stars to come out, protecting and upholding us whether we recognize his hand or not.
These are small things, but they do add up to small stresses throughout the day. It is an expected part of being in a new country and culture. It reminds me not to take for granted when things happen as expected (the bus comes, and on time) here or at home. It reminds me not to be spoiled by expecting things (particular events, my plans, etc.) to happen when and how I would prefer. Things are actually outside of my control - many things, and not just the ones I have noticed. It reminds me to be grateful for the One who holds all things together, sustaining Creation and our bodies, causing the sun to rise and the stars to come out, protecting and upholding us whether we recognize his hand or not.
attention
I was warned before coming here that I would get a lot of attention as a white, Western female in India. I suppose I get some attention (i.e. staring), although it's mostly from small children, but it's certainly not what I expected after a total of ~8 past months in Latin America. When adults here do look at me, they only watch until I am past and never (that I've noticed) turn their heads. I also have not gotten any sound effects like the ones I encountered in Costa Rica and Honduras ("Ch-ch-ch," "Good morning, beautiful," "Hello, how are you?," whistling, etc.).
I have mixed reactions to this. It reminds me of my twin's reaction after her return from a semester in Costa Rica where she got lots of attention for simply walking down the street: "Don't I look nice today or something?" While I remember feeling fed up with the attention at times (can't I just get to my destination without attracting added attention that takes emotional energy even to ignore?), it is still a bit unexpected not to get attention like that at all.
The situation has also reminded me of other times/places in my life where I want attention and am ignored (e.g. the OR almost any time) or get attention I don't want (e.g. an attending's questions regarding a subject about which I remember little). This was especially true last week when I felt fairly ignored by my team at the hospital. It reminds me of how much I can come to depend on others' attention and affirmation for my worth. It also reminds me of how the way I acknowledge or ignore others matters, both in what it communicates to them about their worth and in what the reactions it forms in me. Do I really believe all other human beings I encounter are equally valuable because they are made in the image of God? Or am I happier to encounter a western-looking one or one who speaks English or one who is kind to me or smiles back at me?
The idea of facing someone reminds me of something I thought about a bit my senior year in college, partly due to help in conversations from an art major on my floor. We talked about how part of art is the act of "beholding" the other, accepting who/what they are in order to portray it. I remember thinking at that time about how part of my service in medicine can be a similar act of beholding a patient's illness/pain and not turn away. I can choose not to be disgusted or discouraged, not to be overwhelmed by their suffering, but to offer the accompaniment of my presence and beholding in the midst of it. I think God offers us a similar accompaniment, and one of my favorite portrayals of God's attention to us is the Old Testament idea of God's turning his face toward us, letting the light of his face shine upon us. It is encouraging to me when I see clearly my own quick frustrations or impatience or self-absorption to remember that God is not surprised or disgusted by my sin but continues to turn his face towards me. That is attention that matters.
I have mixed reactions to this. It reminds me of my twin's reaction after her return from a semester in Costa Rica where she got lots of attention for simply walking down the street: "Don't I look nice today or something?" While I remember feeling fed up with the attention at times (can't I just get to my destination without attracting added attention that takes emotional energy even to ignore?), it is still a bit unexpected not to get attention like that at all.
The situation has also reminded me of other times/places in my life where I want attention and am ignored (e.g. the OR almost any time) or get attention I don't want (e.g. an attending's questions regarding a subject about which I remember little). This was especially true last week when I felt fairly ignored by my team at the hospital. It reminds me of how much I can come to depend on others' attention and affirmation for my worth. It also reminds me of how the way I acknowledge or ignore others matters, both in what it communicates to them about their worth and in what the reactions it forms in me. Do I really believe all other human beings I encounter are equally valuable because they are made in the image of God? Or am I happier to encounter a western-looking one or one who speaks English or one who is kind to me or smiles back at me?
The idea of facing someone reminds me of something I thought about a bit my senior year in college, partly due to help in conversations from an art major on my floor. We talked about how part of art is the act of "beholding" the other, accepting who/what they are in order to portray it. I remember thinking at that time about how part of my service in medicine can be a similar act of beholding a patient's illness/pain and not turn away. I can choose not to be disgusted or discouraged, not to be overwhelmed by their suffering, but to offer the accompaniment of my presence and beholding in the midst of it. I think God offers us a similar accompaniment, and one of my favorite portrayals of God's attention to us is the Old Testament idea of God's turning his face toward us, letting the light of his face shine upon us. It is encouraging to me when I see clearly my own quick frustrations or impatience or self-absorption to remember that God is not surprised or disgusted by my sin but continues to turn his face towards me. That is attention that matters.
language(s)
I've mentioned my struggles and frustrations with language learning (or lack thereof) in several posts, so I'll confine this to a comment and a story. I've found interesting the words that do not exist in Tamil, the primary language I'm learning common phrases in. For instance, according to my resident expert (Thenu), there is no word for "please," "excuse me," "good morning," or our commonly used "thank you." There is a word that means the latter but it is formal (nandri) and only used in more formal situations; I used it for a week as an effort at using something Tamil in everyday interactions and then gave up. Tamilians have picked up somewhat the English "thank you"/"thanks" and "good morning", so I use those instead now, as well as "excuse me"/"I'm sorry" when interrupting or bypassing people closely in the street/bus. I also do a lot of nodding and smiling to the mothers sitting with their babies in the wards at the hospital. I almost feel a bit East Asian like the Japanese tradition of bowing to each other. :)
I mentioned before that Thenu taught me the numbers in Tamil. One day last week, I walked onto a mostly full elevator and asked the person nearer the number button board to push "unjeh," or five, for my destination. They looked at me in confusion until someone else in the elevator said, "Fifth floor," and then they pushed the appropriate button. So much for trying to use the little Tamil I know!
People mostly laugh at me when I use my "how are you?" (epidy irkungeh) or "what's your name?" (ongeh pereh eneh). I haven't decided if this is because they're so surprised to see a white person trying to speak Tamil or if I pronounce things so badly. Or maybe it's some combination of the two. I press on anyway. :)
I mentioned before that Thenu taught me the numbers in Tamil. One day last week, I walked onto a mostly full elevator and asked the person nearer the number button board to push "unjeh," or five, for my destination. They looked at me in confusion until someone else in the elevator said, "Fifth floor," and then they pushed the appropriate button. So much for trying to use the little Tamil I know!
People mostly laugh at me when I use my "how are you?" (epidy irkungeh) or "what's your name?" (ongeh pereh eneh). I haven't decided if this is because they're so surprised to see a white person trying to speak Tamil or if I pronounce things so badly. Or maybe it's some combination of the two. I press on anyway. :)
Friday, February 12, 2010
update 2
I've forgotten to mention this, so I'll do it here. Jet lag has been better for about five-six days now, so that is great. I still wake up in the night, but it's more often due to dogs, music, or being hot/cold. And I go back to sleep, so that is great! :)
I am going in for a half-day tomorrow but otherwise am done with the explicitly pediatrics part of my rotation. I really enjoyed it and saw some crazy stuff. I definitely started to feel more like part of the team this week, although most of them still didn't talk to me that much... My interns talked to me a bit more, and others would occasionally make an effort at teaching. But one of them that I never felt like I connected with or was particularly warm to me told me to day that they would miss me when I leave. So I guess they liked me after all! :)
The rest of the Jefferson/South India crew is off to Bangalore this weekend, but I decided to stay home to read up on some of the stuff I'm seeing and still don't have any idea how to recognize/treat, catch up on some blogging on not just life details but what I'm thinking about, and just have some down time. So if you have any specific questions on things I haven't mentioned, the next day or two would be a great time to email/comment them, and I'll try to get back to you promptly.
I am going in for a half-day tomorrow but otherwise am done with the explicitly pediatrics part of my rotation. I really enjoyed it and saw some crazy stuff. I definitely started to feel more like part of the team this week, although most of them still didn't talk to me that much... My interns talked to me a bit more, and others would occasionally make an effort at teaching. But one of them that I never felt like I connected with or was particularly warm to me told me to day that they would miss me when I leave. So I guess they liked me after all! :)
The rest of the Jefferson/South India crew is off to Bangalore this weekend, but I decided to stay home to read up on some of the stuff I'm seeing and still don't have any idea how to recognize/treat, catch up on some blogging on not just life details but what I'm thinking about, and just have some down time. So if you have any specific questions on things I haven't mentioned, the next day or two would be a great time to email/comment them, and I'll try to get back to you promptly.
Wednesday, February 10, 2010
pictures
This is us in the airport in Philly. Step number 1: get used to looking really white in pictures.
Nithya showing off the salwar-kameez with a perfect cup of milky, sweet coffee.
Auto-rickshaws on a crowded road. Note the passenger's salwar-kameez, too.
The typical flowers-in-hair look here along with the whole-family-on-the-motorcycle/scooter that is very common, sometimes with two kids and groceries!
More pics to come later. Note: the pictures are not high-quality since I'm only getting used to using the digital camera and tend to forget you have to hold down the shutter to focus before taking the picture. Ah, well.
work
To give you a few brief details about work: I am on Child Health-1, which is ID and endocrine, although we see a bunch of other stuff. We have outpatient clinic (called OPD) on Mondays and Thursdays, which typically lasts from 8 a.m.-6 or 7 p.m. We have inpatient rounds (called wards) on Tuesdays, Wednesdays, and Fridays, and the residents do brief rounds after I leave on Mondays and Thursdays. They work hard, seeing patients before rounds and after clinic, sometimes staying till 11 p.m.!
I don't do anything by myself but basically function as an observer for both inpatient and outpatient. This is a little frustrating, especially for simple things like typing up discharge summaries copied from the chart or writing prescriptions, but with the language barrier for patient contact and the myriad of diseases I've never seen in the States, it's also a bit relieving. I am reminded of how little I know of how things are done in the States for peds, either, though, since I did a week and a half of inpatient in third year and four weeks of outpatient, most of which was well child checkups. There is well baby clinic here for shots and checkups, but the outpatient clinic is all sick visits.
I've seen some pretty crazy stuff. Cervical lymphadenopathy has turned out to be either Mycobacterium infection (either M. TB or MAI) as well as Hodgkin lymphoma complete with Reed-Sternberg cells on outside biopsy. A baby with apneic spells today got intubated and sent to the ICU and turned out to have an intracranial bleed, so I felt my first bulging anterior fontanelle. I saw a four-year-old who has received nearly forty (or was it sixty?) blood transfusions for beta thalassemia major and had a spleen that caused abdominal distention and was palpable to within centimeters of his pelvis. Many patients have hepatomegaly, and I've felt several spleens that are smaller than that one. I saw a patient with probable Prader-Willi syndrome (feeding difficulty in infancy and failure to thrive followed by uncontrolled weight gain with mental retardation and developmental delay - one of the very few obese patients I've seen), Noonan syndrome (the male version of Turner syndrome), and probable spinal muscular atrophy (SMA - floppy baby with absent reflexes). So some crazy diagnoses and physical findings.
I have to head off to the international student weekly dinner out, but I am enjoying my time, feeling like I am more a part of the team (despite not doing anything), and learning a good bit about all sorts of interesting medical illnesses as well as some Tamil along the way. So far the latter includes numbers 1-10, "how are you?", "how old are you?", "what's your name?", question words, the word for pain, and some body parts. ;)
I don't do anything by myself but basically function as an observer for both inpatient and outpatient. This is a little frustrating, especially for simple things like typing up discharge summaries copied from the chart or writing prescriptions, but with the language barrier for patient contact and the myriad of diseases I've never seen in the States, it's also a bit relieving. I am reminded of how little I know of how things are done in the States for peds, either, though, since I did a week and a half of inpatient in third year and four weeks of outpatient, most of which was well child checkups. There is well baby clinic here for shots and checkups, but the outpatient clinic is all sick visits.
I've seen some pretty crazy stuff. Cervical lymphadenopathy has turned out to be either Mycobacterium infection (either M. TB or MAI) as well as Hodgkin lymphoma complete with Reed-Sternberg cells on outside biopsy. A baby with apneic spells today got intubated and sent to the ICU and turned out to have an intracranial bleed, so I felt my first bulging anterior fontanelle. I saw a four-year-old who has received nearly forty (or was it sixty?) blood transfusions for beta thalassemia major and had a spleen that caused abdominal distention and was palpable to within centimeters of his pelvis. Many patients have hepatomegaly, and I've felt several spleens that are smaller than that one. I saw a patient with probable Prader-Willi syndrome (feeding difficulty in infancy and failure to thrive followed by uncontrolled weight gain with mental retardation and developmental delay - one of the very few obese patients I've seen), Noonan syndrome (the male version of Turner syndrome), and probable spinal muscular atrophy (SMA - floppy baby with absent reflexes). So some crazy diagnoses and physical findings.
I have to head off to the international student weekly dinner out, but I am enjoying my time, feeling like I am more a part of the team (despite not doing anything), and learning a good bit about all sorts of interesting medical illnesses as well as some Tamil along the way. So far the latter includes numbers 1-10, "how are you?", "how old are you?", "what's your name?", question words, the word for pain, and some body parts. ;)
week 1
So, after spending 45 minutes trying to figure out how to get this computer to recognize my USB drive with pictures on it, I have given up and you will have to wait for pictures till I find a computer that recognizes it. Sorry!
On to week one tally:
1 episode of spontaneous tears which I chalk up to a combination of jet lag and frustration at losing my entire team after returning from lunch break and having no idea where to look for them or who to find to understand that I am even looking for them. This ended well in laughter and some Tamil learning with me sitting with the pediatrics librarian in her little room waiting for someone from my team to appear (eventually, someone did).
2 of the four of us got sick, one with gastroenteritis and one with a cold (not me at that time, although I have a cold now)
3 new salwar-kameez(es? - they look kind of like this, except the scarf [dupatta] is worn pulled forward about six inches lower) to wear for the first week and an additional four bought in Chennai this past weekend (on sale - two for the price of one! - the savings joy continues, even in India). These are tailored to my personal measurements, supposedly, although my specifications for neckline so it doesn't feel like it's falling off my shoulders weren't attended to. Ah, well.
4 of us fit into the back seat of a Toyota land cruiser (kind of like this?) for the three-hour trip to and from Chennai three times in the past eleven days
5 mosquito bites (despite dutiful application of mosquito repellent 1-2 times/day - no worries, Mom, I am trying to avoid all the mosquito-carried illnesses I see in the hospital)
innumerable: dogs and cows in the streets, stars visible in the night sky over our campus in Vellore (I taught Thenu to recognize Orion!), idly eaten for breakfast already (rice-flour-like cakes that remind me of the Zambian nsima I will be eating in a few weeks that you eat with sauces like sambar served in little metal bowls like in the picture), water bottles consumed, times I wish I spoke Tamil or Telegu, or Bengali, or Hindi
Highlight of the week: hearing the choir sing the Old Testament priestly blessing at the end of the church service last week. The sound was nearly angellic.
On to week one tally:
1 episode of spontaneous tears which I chalk up to a combination of jet lag and frustration at losing my entire team after returning from lunch break and having no idea where to look for them or who to find to understand that I am even looking for them. This ended well in laughter and some Tamil learning with me sitting with the pediatrics librarian in her little room waiting for someone from my team to appear (eventually, someone did).
2 of the four of us got sick, one with gastroenteritis and one with a cold (not me at that time, although I have a cold now)
3 new salwar-kameez(es? - they look kind of like this, except the scarf [dupatta] is worn pulled forward about six inches lower) to wear for the first week and an additional four bought in Chennai this past weekend (on sale - two for the price of one! - the savings joy continues, even in India). These are tailored to my personal measurements, supposedly, although my specifications for neckline so it doesn't feel like it's falling off my shoulders weren't attended to. Ah, well.
4 of us fit into the back seat of a Toyota land cruiser (kind of like this?) for the three-hour trip to and from Chennai three times in the past eleven days
5 mosquito bites (despite dutiful application of mosquito repellent 1-2 times/day - no worries, Mom, I am trying to avoid all the mosquito-carried illnesses I see in the hospital)
innumerable: dogs and cows in the streets, stars visible in the night sky over our campus in Vellore (I taught Thenu to recognize Orion!), idly eaten for breakfast already (rice-flour-like cakes that remind me of the Zambian nsima I will be eating in a few weeks that you eat with sauces like sambar served in little metal bowls like in the picture), water bottles consumed, times I wish I spoke Tamil or Telegu, or Bengali, or Hindi
Highlight of the week: hearing the choir sing the Old Testament priestly blessing at the end of the church service last week. The sound was nearly angellic.
Tuesday, February 9, 2010
first impressions
This is long overdue since I’ve been here a week and a half, but I wanted to share them anyway. :) I’ll do it in bullet form since that seems simplest for this sort of entry.
1. Seeing city lights from the sky through cloud cover is really gorgeous
2. Lights along the side of the road here are sometimes the long (3 feet?) fluorescent lights instead of the ones I typically see in the States. Why not?
3. Mattresses and pillows are really firm here. I may have to outgrow finally my bad habit of sleeping on my stomach.
4. I’m learning food names in a combination of Nithya’s Telegu and Thenu’s Tamil (gari = vari?). This can be confusing when trying to order.
5. Dipper baths with the option for hot water when heated by flipping a switch to turn on the water heater on the wall (with some patience) are quite refreshing. That said, not having a separate stall or tub for bathing take a little getting used to. Am I supposed to stand in the center of the bathroom or near one side? Does it matter how far from the drain I am?
6. Purchasing things is done very different here, whether it’s a salwar-kameez or my breakfast. You pay at one place, get a receipt, take the receipt to another window, and pick up the item there. When shopping, you may have to go to another place where your item will be bagged. I haven’t decided if this is faster/more efficient or not…
7. Crossing the street is an adventure. So is driving. Three vehicles across in a two-lane highway with auto rickshaws, cows, bicycles, cycle-driven carts, cow-pulled carts, etc. are commonplace. I’ve just decided in both to assume that we will all live to see another day and not to worry. After all, I’ve only seen one car hit a water buffalo crossing the road so far. And cars/trucks don’t really need much more than inches when passing other vehicles after all, do they?
I'll try to post again later after dinner.
1. Seeing city lights from the sky through cloud cover is really gorgeous
2. Lights along the side of the road here are sometimes the long (3 feet?) fluorescent lights instead of the ones I typically see in the States. Why not?
3. Mattresses and pillows are really firm here. I may have to outgrow finally my bad habit of sleeping on my stomach.
4. I’m learning food names in a combination of Nithya’s Telegu and Thenu’s Tamil (gari = vari?). This can be confusing when trying to order.
5. Dipper baths with the option for hot water when heated by flipping a switch to turn on the water heater on the wall (with some patience) are quite refreshing. That said, not having a separate stall or tub for bathing take a little getting used to. Am I supposed to stand in the center of the bathroom or near one side? Does it matter how far from the drain I am?
6. Purchasing things is done very different here, whether it’s a salwar-kameez or my breakfast. You pay at one place, get a receipt, take the receipt to another window, and pick up the item there. When shopping, you may have to go to another place where your item will be bagged. I haven’t decided if this is faster/more efficient or not…
7. Crossing the street is an adventure. So is driving. Three vehicles across in a two-lane highway with auto rickshaws, cows, bicycles, cycle-driven carts, cow-pulled carts, etc. are commonplace. I’ve just decided in both to assume that we will all live to see another day and not to worry. After all, I’ve only seen one car hit a water buffalo crossing the road so far. And cars/trucks don’t really need much more than inches when passing other vehicles after all, do they?
I'll try to post again later after dinner.
Wednesday, February 3, 2010
quick update
I still do not have my own internet access and so am using a public, shared computer at the international student hostel (dorm) where the boys are staying. We girls are at a farther, cheaper hostel since the international one was apparently full by the time they figured out we're both girls and want to stay together. :( Ah, well. So I'll try to update more completely in the coming days when I have my own internet username and password.
Jetlag continues, although Nithya's reminder that it is worse when she travels from California (waking at 1 a.m.) reminds me to be grateful that I wake at 4 a.m. I'm also reminded to be happy I'm normally a very good sleeper (right, Deana?). :)
My pediatrics rotation has been interesting - a combination of inpatient and outpatient, although I don't know much about what's going on for either one! I've seen a lot more congenital heart defects than I had previously (ASD, small VSD, PDA for you medical types) as well as infectious disease things I definitely haven't seen before (e.g. scrub typhus, dengue, extrapulmonary TB leading to psoas abscess and vertebral osteomyelitis). The differential for meningitis includes TB, a rare consideration in the States, and I've seen at least one LP (lumbar puncture = spinal tap) each day on the inpatient wards.
I'm slowly meeting other international students through planned functions (a reception Monday night, dinner out tonight) and very slowly getting to know the residents (called post-graduates) on my team. I find the language barrier predictably frustrating, although I remind myself that even if I knew Tamil (the state-predominant language here), I still wouldn't know Telegu or Bengali or Hindi or Malayalam... So I smile a lot and nod my head at people; I haven't picked up the Indian side to side head wobble yet!
I'm off to a dipper bath now and then bed before my 4 a.m. wake-up call with dogs barking and birds calling. More updates and stories later!
Jetlag continues, although Nithya's reminder that it is worse when she travels from California (waking at 1 a.m.) reminds me to be grateful that I wake at 4 a.m. I'm also reminded to be happy I'm normally a very good sleeper (right, Deana?). :)
My pediatrics rotation has been interesting - a combination of inpatient and outpatient, although I don't know much about what's going on for either one! I've seen a lot more congenital heart defects than I had previously (ASD, small VSD, PDA for you medical types) as well as infectious disease things I definitely haven't seen before (e.g. scrub typhus, dengue, extrapulmonary TB leading to psoas abscess and vertebral osteomyelitis). The differential for meningitis includes TB, a rare consideration in the States, and I've seen at least one LP (lumbar puncture = spinal tap) each day on the inpatient wards.
I'm slowly meeting other international students through planned functions (a reception Monday night, dinner out tonight) and very slowly getting to know the residents (called post-graduates) on my team. I find the language barrier predictably frustrating, although I remind myself that even if I knew Tamil (the state-predominant language here), I still wouldn't know Telegu or Bengali or Hindi or Malayalam... So I smile a lot and nod my head at people; I haven't picked up the Indian side to side head wobble yet!
I'm off to a dipper bath now and then bed before my 4 a.m. wake-up call with dogs barking and birds calling. More updates and stories later!
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