Mtzcchh.
So I think this is going to be the last entry from Chennai. Its been fun. Its been real. But its never been both. Actually, the trip has been wonderful. I know that I’ve had a very skewed view of living here – I stayed at a really nice place, was driven around everywhere, had generally continuous access to air conditioning backed up by generators in the case of power outages, had my cooking/cleaning/everything done for me. I haven’t even been bitten by a mosquito yet. Although I do have 2 days left. But the funnest and most memorable times were definitely the ones that were outside of those comforts: being on the inpatient wards with its, um, distinct aroma (and fans only if we’re lucky ), scurrying around town in the autos, almost evaporating in the heat of Parry’s Corner and savoring the coolness of the bottle of cola given to me to quench my thirst, eating the pani puri served to you while standing from a guy with questionable hand hygiene, maneuvering through Pondy Bazaar in T. Nagar with 10,000,000 people jam packed around you.
Of course I’m going to miss seeing these patients who really need so little to do so well; I’m going to miss the wonderful and amazing staff here at YRG Care who work really hard for all of their patients. But the miscellaneous random things are there too---
Top Ten Miscellaneous Things I’m going to miss:
1. Waking up everyone morning to cooked breakfast brought to my room: omlette, toast, spicy ketchup, and a cup of sweeeeeeet chai. I think they put a little bit of tea into a cup of sugar actually.
2. Getting driven to work.
3. Having the security guard stand up, salute me and say ‘Good morning Madam” every time I walk into the hospital. I’ve been tempted to say ‘at ease, soldier.” Maybe tomorrow.
4. Rooftop coffee breaks every day at 10 am and 4 pm. And rooftop lunches. Dr. Solomon calls it the ‘Sky Café.’
5. Getting driven back home.
6. Mango milkshake waiting for me on my arrival home.
7. All the cool ringtones people use here – from bhangra to r Kelley to andrea bocelli. The silent/vibrate mode is just not an option.
8. Wearing shalwar kameez to work.
9. Wearing jasmine in my hair even to work.
10. The sound that everyone in Chennai makes with their mouth when they’re trying to explain something and feel like its not getting conveyed, or when they’re exasperated, or tell a story where something didn’t make sense, or just because. Its hard to really describe, but it sounds kinda like ‘Mtzcchhh’, and its made by pressing the lips together and then kinda making a tsk movement with your whole tongue flat against the palate. You can even do it out of the side of your mouth. Try it. Its fun.
Top Ten Miscellaneous Things I’m not going to miss:
1. Waking up to one of the servants alarm clock or cell phone at 6 am to the muzak tones of the Celine Dion Titanic song – my heart will go on.
2. Extremely late dinners – usually around 10 or 11 pm at night – but they were so tasty!
3. All the weight I’ve put on (see number 2, and numbers 1 and 6 in previous list).
4. The um, bluntness, of the commentary on physical appearance, e.g., “You are looking very dull today, like you just woke up from the dead. Why?” or “The way your neck bones stick out is not attractive. You should do something about that or wear things that cover them up.” Although someone did tell me last night that they loved the sound of my deep voice and wished they could listen to it all day – the fact that it was a married woman with a kid may be a little strange, but it was still nice J
5. Sari shopping
6. Sari shopping
7. Sari shopping
8. the funny tan line on my feet from the sandals + continuous sun
9. having to carry a water bottle around everywhere just in case I get thirsty per everyone’s insisitence.
10. did I mention sari shopping?
I’m dreading the long flight home, partly because its sad to leave, but mostly because of the long flight home. I really can’t wait for that whole ‘beam me up Scotty’ thing to come through.
The receptionist just brought some sweets in – apparently one of the patients just delivered a healthy baby and wanted her to distribute them to everyone. I’m going to miss that too.
Thanks for all of your emails and responses. Its been fun. Its been real. And it has been both.
(Last couple of pics)
http://brown.facebook.com/album.php?aid=6425&l=c0d00&id=677507396
Friday, June 15, 2007
Thursday, June 7, 2007
June 8th, 2007
Hey, it was kinda labor intensive to add pictures here because of the slow computer connection, so check out http://brown.facebook.com/album.php?aid=5756&l=978cd&id=677507396 .
June 7th, 2007
Only a little over 1 week left and I still have so much to do! Exactly what, I’m not 100% sure, but I know there’s a lot! I know my mom’s and sisters’ answer – their shopping.
So I went to Parry’s Corner yesterday. It’s a part of Chennai where all the ‘wholesale’ shopping is done. I’m not 100% sure what that means, but I believe ‘smuggled’ and ‘dangerous’ is in there somewhere. Someone told me there used to be some cake or pastry shop named Parry’s so the area around the store became known as Parry’s Corner. The shop closed, but the Corner stayed. I went there to look for cloth with the tailor for Nandhitha’s wedding reception bags. Man oh man. I learned the reason why they don’t bother with deodorant here – at this temperature, with this many people and animals, you just can’t fight it. My sweat was sweating. And its super crowded. I wouldn’t survive very long in the Corner for 2 reasons–
1. I have a tendency to look around aimlessly when I’m walking around and not really pay too much attention to my surroundings;
2. I tend to operate under the assumption that pedestrians have the right of way.
In India, EVERYBODY/THING has the right of way. As such, I almost got ran over at least 6 times, by both animal and machine. I couldn’t even get upset. My nonoffensive meandering was clearly in the wrong.
Although the service sector is alive and well in India. I was eating at this food court (pizza hut, subway, kfc if you want – I went with the mixed chat at ghangothree) with some friends in this fancy schmancy mall (will attach pictures) with a movie theater that was one of the nicest I’ve ever been to anywhere in the US and, and, and you can also snack on samosas, chaat, chai etc in addition to nachos/popcorn/Cadburys. Anyways, I got up to take my tray up and these 4 guys started running towards me. I didn’t know what the heck was happening, and for a second I thought I was going to get arrested! I almost dropped my tray – which is exactly what they wanted me to do. Job security, you see.
We saw Pirates at the theater. I know, I know. I traveled halfway across the world to see an American movie. But that’s what the Indians wanted to see. And I have to say, the movie audience is a lot more interactive here. I thought it would be restricted to the Indian movies, but people whistled every time Johnny Depp came on screen, hooted and cat-called at Keira, and clapped and cheered throughout. The king of Tamil movies is an actor named Rajnikant and he is reportedly the highest paid actor in India, I think making $8-10 million per picture. Dollars. Anyways, his next movie, the first one in a while, Sivaji, is opening June 15th. They say its chaos when his movies open, and at each cinema, there will be prayers and blessed fruit, milk, and flowers presented to his CARDBOARD CUTOUTS. The milk is supposedly poured into his ‘mouth.’ I can’t wait.
In the meantime, back to figuring out what I have left to do. Oh yeah, my work. Dang.
So I went to Parry’s Corner yesterday. It’s a part of Chennai where all the ‘wholesale’ shopping is done. I’m not 100% sure what that means, but I believe ‘smuggled’ and ‘dangerous’ is in there somewhere. Someone told me there used to be some cake or pastry shop named Parry’s so the area around the store became known as Parry’s Corner. The shop closed, but the Corner stayed. I went there to look for cloth with the tailor for Nandhitha’s wedding reception bags. Man oh man. I learned the reason why they don’t bother with deodorant here – at this temperature, with this many people and animals, you just can’t fight it. My sweat was sweating. And its super crowded. I wouldn’t survive very long in the Corner for 2 reasons–
1. I have a tendency to look around aimlessly when I’m walking around and not really pay too much attention to my surroundings;
2. I tend to operate under the assumption that pedestrians have the right of way.
In India, EVERYBODY/THING has the right of way. As such, I almost got ran over at least 6 times, by both animal and machine. I couldn’t even get upset. My nonoffensive meandering was clearly in the wrong.
Although the service sector is alive and well in India. I was eating at this food court (pizza hut, subway, kfc if you want – I went with the mixed chat at ghangothree) with some friends in this fancy schmancy mall (will attach pictures) with a movie theater that was one of the nicest I’ve ever been to anywhere in the US and, and, and you can also snack on samosas, chaat, chai etc in addition to nachos/popcorn/Cadburys. Anyways, I got up to take my tray up and these 4 guys started running towards me. I didn’t know what the heck was happening, and for a second I thought I was going to get arrested! I almost dropped my tray – which is exactly what they wanted me to do. Job security, you see.
We saw Pirates at the theater. I know, I know. I traveled halfway across the world to see an American movie. But that’s what the Indians wanted to see. And I have to say, the movie audience is a lot more interactive here. I thought it would be restricted to the Indian movies, but people whistled every time Johnny Depp came on screen, hooted and cat-called at Keira, and clapped and cheered throughout. The king of Tamil movies is an actor named Rajnikant and he is reportedly the highest paid actor in India, I think making $8-10 million per picture. Dollars. Anyways, his next movie, the first one in a while, Sivaji, is opening June 15th. They say its chaos when his movies open, and at each cinema, there will be prayers and blessed fruit, milk, and flowers presented to his CARDBOARD CUTOUTS. The milk is supposedly poured into his ‘mouth.’ I can’t wait.
In the meantime, back to figuring out what I have left to do. Oh yeah, my work. Dang.
Friday, June 1, 2007
June 1st, 2007
I’m officially a fob. Or I guess I will be once I land back in the States. This morning, I ran into one of the docs who asked if I had gotten his text message last night. I actually said, “I’m soooo sorry da, I got the message roomba late and so didn’t have a chance to SMS back” intermittently dragging out my words but still speaking rapidly, head wagging back and forth, hands gesturing manically et al. I caught myself at the end and busted out laughing. As did he. When in Rome, eh?
Today was the first day of mandatory helmets for all motorcycle riders in Chennai. Can you believe it? This is the law in this city, in this resource constrained country, and its not even the law in RI, or OH if I remember correctly. The bike shops were packed yesterday with folks trying to get a helmet before the law went into effect today, and some shops even sold out before close. I don’t know this first hand of course- one of the attendings, Bella, was on the hunt last night and she came back empty-handed. I wonder… if a motorcycle is carrying 5 passengers, which it is apt to do in India, would all the ‘pillions’ require a helmet?
I wish I’d had a camera on the way to work this morning. I find myself wishing that a lot, and I don’t know if its truly because of the novelty of the things here, or my own awakened perceptions because I am in a new place. Well, kinda new. So four grown men were walking side by side, and each had his right arm around the back over the shoulder of the man to his right. They were just walking down the road that way, happy as clams. It didn’t see a parade, and Boat Club Road is not quite Castro Street. Certainly doesn’t explain the 1 billion + folks here.
So I got a lot of emails that I made folks sad and depressed with my blog about the pediatric outpatient clinic. I promise that wasn’t my intent… it was just an experience that I had that I wanted to share, admittedly a really intense one. So to make up for it, here is a happy story. Well, I guess not completely cute kittens and cotton candy since it involves an infected couple. You’ll have to cut me some slack - I’m working at an HIV hospital.
So, a couple walked in today with smiles as wide as the Ganges. Or maybe the Amazon. Whichever is wider. Anyways, not the usual way patients look when they show up for their follow-up appointments. The gentleman was carrying what looked like a small plastic trash can which was lined with a plastic bag; his wife’s hair was swathed in jasmine and rose garlands. He was kinda giggling and saying something to the doc there, and he reached into the trash can and handed me 2 pieces of candy – Nestle éclairs which, as sacrilegious as it may sound coming from me, were better than Cadbury’s. Anyways, he talked for a while and then his wife did as well. Apparently, their first grandchild, a granddaughter, was born last week. They were ecstatic. When they had been diagnosed almost 9 years ago (he had received a blood transfusion several years prior following a cholecystectomy and then had infected his wife; he got tested b/c he’d heard that people who had received transfusions were at risk) neither of them thought they would be alive for this moment. Miraculously, both are doing well off of meds even though the have been infected for more than 10 years – they are probably long term nonprogessors of the infection which is rare. The doc told them they would likely be there to dance at their granddaughter’s wedding.
There’s a plan tomorrow night for Thai food and a Hindi movie. Shootout at Lokhwanda. Or something like that. I voted for ‘Cheeni Kum- A Sugar Free Romance’ but nobody else wanted to see Amitabh Bachan with a ponytail. But its with Tabu, yaar!
Today was the first day of mandatory helmets for all motorcycle riders in Chennai. Can you believe it? This is the law in this city, in this resource constrained country, and its not even the law in RI, or OH if I remember correctly. The bike shops were packed yesterday with folks trying to get a helmet before the law went into effect today, and some shops even sold out before close. I don’t know this first hand of course- one of the attendings, Bella, was on the hunt last night and she came back empty-handed. I wonder… if a motorcycle is carrying 5 passengers, which it is apt to do in India, would all the ‘pillions’ require a helmet?
I wish I’d had a camera on the way to work this morning. I find myself wishing that a lot, and I don’t know if its truly because of the novelty of the things here, or my own awakened perceptions because I am in a new place. Well, kinda new. So four grown men were walking side by side, and each had his right arm around the back over the shoulder of the man to his right. They were just walking down the road that way, happy as clams. It didn’t see a parade, and Boat Club Road is not quite Castro Street. Certainly doesn’t explain the 1 billion + folks here.
So I got a lot of emails that I made folks sad and depressed with my blog about the pediatric outpatient clinic. I promise that wasn’t my intent… it was just an experience that I had that I wanted to share, admittedly a really intense one. So to make up for it, here is a happy story. Well, I guess not completely cute kittens and cotton candy since it involves an infected couple. You’ll have to cut me some slack - I’m working at an HIV hospital.
So, a couple walked in today with smiles as wide as the Ganges. Or maybe the Amazon. Whichever is wider. Anyways, not the usual way patients look when they show up for their follow-up appointments. The gentleman was carrying what looked like a small plastic trash can which was lined with a plastic bag; his wife’s hair was swathed in jasmine and rose garlands. He was kinda giggling and saying something to the doc there, and he reached into the trash can and handed me 2 pieces of candy – Nestle éclairs which, as sacrilegious as it may sound coming from me, were better than Cadbury’s. Anyways, he talked for a while and then his wife did as well. Apparently, their first grandchild, a granddaughter, was born last week. They were ecstatic. When they had been diagnosed almost 9 years ago (he had received a blood transfusion several years prior following a cholecystectomy and then had infected his wife; he got tested b/c he’d heard that people who had received transfusions were at risk) neither of them thought they would be alive for this moment. Miraculously, both are doing well off of meds even though the have been infected for more than 10 years – they are probably long term nonprogessors of the infection which is rare. The doc told them they would likely be there to dance at their granddaughter’s wedding.
There’s a plan tomorrow night for Thai food and a Hindi movie. Shootout at Lokhwanda. Or something like that. I voted for ‘Cheeni Kum- A Sugar Free Romance’ but nobody else wanted to see Amitabh Bachan with a ponytail. But its with Tabu, yaar!
Wednesday, May 30, 2007
Stardate 5.29.2007
I will apologize in advance… the rest of my entries are going to be way less thought provoking compared to the last one. But I will try to make them at least interesting, i.e., thorough documentation of my general stupidity and clumsiness.
I won a wet kameez contest today. I guess its not really much to brag about - I was the only participant. I was with Dr. Poongalilly in clinic (that’s not how you really spell it, but that’s what it sounds like) seeing her outpatients with her; a patient had just left her office and she was looking up some stuff on the computer. I decided to use the lull in patient flow to try my hand again at drinking from my water bottle without putting my mouth on the rim. Imagine a cascading waterfall right into the mouth. Apparently, that’s the way they roll here. I didn’t realize that until after I got some funny looks at lunch while chugging from my water bottle. I guess most people share water bottles so drinking that way is the polite thing to do and then it just becomes a general habit after that. So here I go, trying not to drench myself yet again, when a knock comes at the door, and enters Dr. Suniti with representatives from the Prime Minister’s office who had come to visit the clinic. Lo and behold.... Niagara Falls all over the front of my kameez. Dr. Suniti, who either didn’t notice or pretended not to, introduced me as “Dr. Aadia visiting from Brown University but who is also from Pakistan but we still let her in the country.” There was some fake laughter and then some pointed looks at the front of my shirt. I just looked meekly and waved.
There was this little lady who had come back for follow-up lab results. Apparently she had 2 previous urine cultures which grew erysipelothorix rhusiopathiae, an organism which typically is found in raw meats – usually pigs and fish - and is known to cause a cellulitis or skin infection in farmers, butchers, anglers, and housewives. She had apparently also grown it in skin culture of that area although blood cultures, echo were negative. She had been treated with ceftriaxone and her repeat urine cultures were negative so good news. The question remained as to how this organism had arrived at this particular location. In the interest of prevention of course, Dr. Poongalilly and I spent a little time trying to outdo each other (read: grossing ourselves out) with hypotheses on how she may have acquired the infection. I won. Can’t say how in public print. Wow, that was 2 wins for me today!
More on the ‘Aadia is a retard’ front: Halfway through morning prayers today, I remembered that Mecca is no longer to the east. Whoops. I turned directions mid-prayer I guess kinda like the historic Jerusalem to Mecca switch. Hope the last 4 days still go in the record books. The world is round, right?
In other news, I saw Howl’s Moving Castle. The family I’m staying with (my friend Nandhitha’s parents) had some visitors today from the U.S. and there is a 13 year-old girl who brilliantly brought a ton of dvds and her laptop for her India sojourn. I thought the movie was fantastic.
Though there was a downside to the new visitors. If I have to watch Nandhitha and Kanna’s wedding video one more time, I’m going to burn myself on a pyre.
Till next time – hopefully more captivating things will happen and it won’t just be a continued treatise of my idiocy. One can wish.
I won a wet kameez contest today. I guess its not really much to brag about - I was the only participant. I was with Dr. Poongalilly in clinic (that’s not how you really spell it, but that’s what it sounds like) seeing her outpatients with her; a patient had just left her office and she was looking up some stuff on the computer. I decided to use the lull in patient flow to try my hand again at drinking from my water bottle without putting my mouth on the rim. Imagine a cascading waterfall right into the mouth. Apparently, that’s the way they roll here. I didn’t realize that until after I got some funny looks at lunch while chugging from my water bottle. I guess most people share water bottles so drinking that way is the polite thing to do and then it just becomes a general habit after that. So here I go, trying not to drench myself yet again, when a knock comes at the door, and enters Dr. Suniti with representatives from the Prime Minister’s office who had come to visit the clinic. Lo and behold.... Niagara Falls all over the front of my kameez. Dr. Suniti, who either didn’t notice or pretended not to, introduced me as “Dr. Aadia visiting from Brown University but who is also from Pakistan but we still let her in the country.” There was some fake laughter and then some pointed looks at the front of my shirt. I just looked meekly and waved.
There was this little lady who had come back for follow-up lab results. Apparently she had 2 previous urine cultures which grew erysipelothorix rhusiopathiae, an organism which typically is found in raw meats – usually pigs and fish - and is known to cause a cellulitis or skin infection in farmers, butchers, anglers, and housewives. She had apparently also grown it in skin culture of that area although blood cultures, echo were negative. She had been treated with ceftriaxone and her repeat urine cultures were negative so good news. The question remained as to how this organism had arrived at this particular location. In the interest of prevention of course, Dr. Poongalilly and I spent a little time trying to outdo each other (read: grossing ourselves out) with hypotheses on how she may have acquired the infection. I won. Can’t say how in public print. Wow, that was 2 wins for me today!
More on the ‘Aadia is a retard’ front: Halfway through morning prayers today, I remembered that Mecca is no longer to the east. Whoops. I turned directions mid-prayer I guess kinda like the historic Jerusalem to Mecca switch. Hope the last 4 days still go in the record books. The world is round, right?
In other news, I saw Howl’s Moving Castle. The family I’m staying with (my friend Nandhitha’s parents) had some visitors today from the U.S. and there is a 13 year-old girl who brilliantly brought a ton of dvds and her laptop for her India sojourn. I thought the movie was fantastic.
Though there was a downside to the new visitors. If I have to watch Nandhitha and Kanna’s wedding video one more time, I’m going to burn myself on a pyre.
Till next time – hopefully more captivating things will happen and it won’t just be a continued treatise of my idiocy. One can wish.
May 27th, 2007
May 27th, 2007
Today was pediatric outpatient clinic day. This amazing pediatrician from Mysore, Dr. Moti – like his name, a true gem of a person- comes into town one Sunday every 2-3 months to see the pediatric patients at YRG. In fact, Dr. Moti works at his Mysore clinic on Saturday, takes an overnight train which arrives around 8 am in Chennai, gets picked up and brought to the clinic here which starts around 9 am, and then he’ll leave and take the 9 pm train back to Mysore Sun night which will get to Mysore on Monday morning around 8 am where he says his ‘cruel’ brother picks him up only to sadistically and joyfully drop him off at his clinic for another full day of work!
There are about 300 total kids under care at YRG, and he’ll usually see between 80-90 of them each Sunday visit. Most of the kids became positive from vertical transmission (from mom) although there are some who seroconverted after blood transfusion or use of unsterilized surgical instruments. In this population, almost 90% of the women contracted the disease from their respective spouses. The clinic is usually regular f/u visits, although some of the kids are sick. If they become sick when Dr. Moti is not available, they’re just seen by one of the other 4 HIV clinic doctors.
It was a light day relatively speaking; we only saw 74 kids. In the room was Dr. Moti, myself, Dr. Preeta – a recent graduate of Madras Medical College who is one of the inpatient doctors, and Kishore – the hospital administrator who served as the Telugu translator/chai orderer/ copy maker/patient caller. I have to say, it was heart wrenching every time one of those kids walked through the door. I remembered exactly why I couldn’t do pediatrics – it hurts too much to see sick kids. I don’t mean to sound so trite and sentimental, but I’m not kidding – each kid was amazing. Most of them bounced in, sat in the exam chair and, as schools have just let out for vacation, reported that they had just finished first in their class. There must be a ton of schools out there cause I swear each kid was ‘top’ in their school.
So each kid got a Cadbury éclair when they walked in and a bag full of biscuits and snacks when they left on their way to their next stop – the dentist, duh esp after what we gave them. They were so cute. I was helping out by filling out a survey for a study on the nutrition status of HIV positive kids in south India. Most of the stuff was observational – like the status of their skin, hair, oral hygiene, etc, but 2 questions had to be asked - appetite and diarrhea which I learned pretty fast in Tamilian english – “sappriya ok?” and “loose motion?”
There were a few moments that really stick out in my mind from this day. The first was this 10 year old girl in pigtails and bright red bows (also finished first in class) who has been orphaned by the disease. Dr. Moti was telling her uncle about medications and f/u when she turned to Dr. Moti with a big smile on her face and said – “Doctor, what is the CD4? Is it good?” Everyone laughed at her earnestness; they say she doesn’t know she has HIV, she just knows that everyone is always talking about CD4. I asked her what CD4 is, and she said it’s a blood test and if its good, that means she is healthy. I think she knows more than they think.
Then a young woman came in with a baby, probably about 3 months old. I had already started filling out the nutrition survey when Dr. Moti said to hold off since the mother was here to find out the serostatus of the baby. The mother had found out late in her pregnancy about her HIV status, but did have a c-section and the baby received meds afterwards to prevent transmission. The results weren’t in the chart. Kishore said he would go run to the lab and get the results. We all sat in the room with our fingers crossed doing our own prayers while we waited for Kishore. He walked in and handed Dr. Moti the paper –NEGATIVE! The mother, after kissing her baby 100 times, fell to Dr. Moti’s feet crying telling him thank you, thank you, thank you, thank you. Dr. Moti picked her up and told her the only way to thank anyone is to take care of yourself and your child and then he passed the Cadbury éclairs to everyone in the room to eat in celebration– we were all crying by then.
Then there was an 11 year old girl who came in with her also positive 6 year old sister. She is the proverbial big sis telling her hyper but super cute younger sis to calm down and be quiet in front of the doctors. Her mom, clothed in a head-to-toe burkha, told us that while riding in an autorickshaw on the way to clinic, big sis had announced to them she wants to go to the university that they passed and be a teacher; it was Anna University which is apparently quite reputable. Dr. Moti said, oh wow, you want to go this university? She looked up at him level in the eye and said, in English, ‘Its up to God. Its all up to God.’ Dang.
Okay, no grandiose summaries of understanding the meaning of life and my place in it. But I will say this -I don’t know if these children know if they have HIV or if they do, what that means. Dr. Suniti Solomon, or Madame as she is referred to at YRG which she runs, came in and talked about the complexities of disclosure to children – when to do it, how to do it, whether to bypass the parents if they are refusing to agree. Both she and Dr. Moti had stories of children who, when they were told they had HIV, responded that they knew for several years; one, because she had been alienated by her teachers at boarding school – having to bring her own plates to the canteen, being given meds at the infirmary that were thrown at her rather than handed to her; another because he had been told by an uncle that he could never get married and asked him why. Neither of them had the support of family, care providers, and counseling staff at the most crucial time. I think the children, like the girl in red bows, understand a lot more than we give them credit for though. Although cultural barriers will probably always be steep, the empowerment of knowledge can serve as the rope to help us traverse them. Just a thought.
Today was pediatric outpatient clinic day. This amazing pediatrician from Mysore, Dr. Moti – like his name, a true gem of a person- comes into town one Sunday every 2-3 months to see the pediatric patients at YRG. In fact, Dr. Moti works at his Mysore clinic on Saturday, takes an overnight train which arrives around 8 am in Chennai, gets picked up and brought to the clinic here which starts around 9 am, and then he’ll leave and take the 9 pm train back to Mysore Sun night which will get to Mysore on Monday morning around 8 am where he says his ‘cruel’ brother picks him up only to sadistically and joyfully drop him off at his clinic for another full day of work!
There are about 300 total kids under care at YRG, and he’ll usually see between 80-90 of them each Sunday visit. Most of the kids became positive from vertical transmission (from mom) although there are some who seroconverted after blood transfusion or use of unsterilized surgical instruments. In this population, almost 90% of the women contracted the disease from their respective spouses. The clinic is usually regular f/u visits, although some of the kids are sick. If they become sick when Dr. Moti is not available, they’re just seen by one of the other 4 HIV clinic doctors.
It was a light day relatively speaking; we only saw 74 kids. In the room was Dr. Moti, myself, Dr. Preeta – a recent graduate of Madras Medical College who is one of the inpatient doctors, and Kishore – the hospital administrator who served as the Telugu translator/chai orderer/ copy maker/patient caller. I have to say, it was heart wrenching every time one of those kids walked through the door. I remembered exactly why I couldn’t do pediatrics – it hurts too much to see sick kids. I don’t mean to sound so trite and sentimental, but I’m not kidding – each kid was amazing. Most of them bounced in, sat in the exam chair and, as schools have just let out for vacation, reported that they had just finished first in their class. There must be a ton of schools out there cause I swear each kid was ‘top’ in their school.
So each kid got a Cadbury éclair when they walked in and a bag full of biscuits and snacks when they left on their way to their next stop – the dentist, duh esp after what we gave them. They were so cute. I was helping out by filling out a survey for a study on the nutrition status of HIV positive kids in south India. Most of the stuff was observational – like the status of their skin, hair, oral hygiene, etc, but 2 questions had to be asked - appetite and diarrhea which I learned pretty fast in Tamilian english – “sappriya ok?” and “loose motion?”
There were a few moments that really stick out in my mind from this day. The first was this 10 year old girl in pigtails and bright red bows (also finished first in class) who has been orphaned by the disease. Dr. Moti was telling her uncle about medications and f/u when she turned to Dr. Moti with a big smile on her face and said – “Doctor, what is the CD4? Is it good?” Everyone laughed at her earnestness; they say she doesn’t know she has HIV, she just knows that everyone is always talking about CD4. I asked her what CD4 is, and she said it’s a blood test and if its good, that means she is healthy. I think she knows more than they think.
Then a young woman came in with a baby, probably about 3 months old. I had already started filling out the nutrition survey when Dr. Moti said to hold off since the mother was here to find out the serostatus of the baby. The mother had found out late in her pregnancy about her HIV status, but did have a c-section and the baby received meds afterwards to prevent transmission. The results weren’t in the chart. Kishore said he would go run to the lab and get the results. We all sat in the room with our fingers crossed doing our own prayers while we waited for Kishore. He walked in and handed Dr. Moti the paper –NEGATIVE! The mother, after kissing her baby 100 times, fell to Dr. Moti’s feet crying telling him thank you, thank you, thank you, thank you. Dr. Moti picked her up and told her the only way to thank anyone is to take care of yourself and your child and then he passed the Cadbury éclairs to everyone in the room to eat in celebration– we were all crying by then.
Then there was an 11 year old girl who came in with her also positive 6 year old sister. She is the proverbial big sis telling her hyper but super cute younger sis to calm down and be quiet in front of the doctors. Her mom, clothed in a head-to-toe burkha, told us that while riding in an autorickshaw on the way to clinic, big sis had announced to them she wants to go to the university that they passed and be a teacher; it was Anna University which is apparently quite reputable. Dr. Moti said, oh wow, you want to go this university? She looked up at him level in the eye and said, in English, ‘Its up to God. Its all up to God.’ Dang.
Okay, no grandiose summaries of understanding the meaning of life and my place in it. But I will say this -I don’t know if these children know if they have HIV or if they do, what that means. Dr. Suniti Solomon, or Madame as she is referred to at YRG which she runs, came in and talked about the complexities of disclosure to children – when to do it, how to do it, whether to bypass the parents if they are refusing to agree. Both she and Dr. Moti had stories of children who, when they were told they had HIV, responded that they knew for several years; one, because she had been alienated by her teachers at boarding school – having to bring her own plates to the canteen, being given meds at the infirmary that were thrown at her rather than handed to her; another because he had been told by an uncle that he could never get married and asked him why. Neither of them had the support of family, care providers, and counseling staff at the most crucial time. I think the children, like the girl in red bows, understand a lot more than we give them credit for though. Although cultural barriers will probably always be steep, the empowerment of knowledge can serve as the rope to help us traverse them. Just a thought.
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