This morning I sat in on regular tradition at CRHP: the final presentations of a group that had come in for a month of training. In these presentations, groups of around 5 people discuss a hypothetical NGO that they have envisioned, the location in which they would, the methods they would employ, and the results they would hope to achieve. It’s a big game of what if. The judges tend to assess the groups on whether or not they think the organization would work. But me? I can’t shake the feeling that some would work and others wouldn’t, and that the content of the presentation would have almost NOTHING to do with the actual outcome.

At first glance, an easy out would be to say that there a millions of unpredictable factors that could derail a NGO like those presented and that a presentation can’t possibly plan for them, but I think that’s crap. It’s a cop out. While there are millions of things beyond the control of a hopeful NGO, there remains a single – perhaps most important – factor that can be controlled and that is a powerful determinant of success.

Let me tell a quick anecdote to illustrate my point. Two NGOs with identical models, plans, and techniques set up new bases in two separate locations. Full of excitement, they launch their first community meetings and are pleased to have modest attendance. They plan with the people there and soon launch programs calculated to address the needs of the communities. In one community, it works spectacularly. Things go as planned like a breeze, key information is brought up, adjustments are made, and the outcomes are spectacular.

However, in the second, things couldn’t be more different. The program starts strong, but after a while attendance and participation start to fall off. Incentives are introduced to get people to come, and this works for a while, but people are clearly in the program only for the incentives. During an evaluation cycle, the NGO is forced to acknowledge that any positive change has been minimal and fleeting.

A community meeting led by Dr. Shobha Arole in a village nearby the Jamkhed area.

What’s the difference? Same approach, same technique, yet starkly contrasting results. Is it fair enough to just say that perhaps the approach was better suited to one place? Maybe one NGO had better staff and “listened” better? Maybe one was better at adjustments?

All these things may be true, but imagine for one second that they’re not. All other things being equal, I think the biggest issue can be articulated in two simple words: Community Capacity.

Community Capacity, in this instance, refers the ability of a community to act as a collective unit while drawing upon the full diversity of available resources. In this reckoning, the components of a community are NOT individual people but instead the roles that individuals play. Individual people can come and ago, but certain roles will tend to persist over time. Thus, community capacity can be stable even if a community is dynamic (this holds only to a certain extent, of course).

Let me quote my mentor, Dr. David P. Aday Jr., here: “[Communities] are more than place-names, locations, and populations.  They are structural arrangements comprising positions, relationships, histories, cultures, and resources. People participate in diverse and variable ways…”

So what does this mean for our NGOs? Simple. It means that the one of the strongest determinants of their future success or failure likely was set BEFORE their first foray into the community for the inaugural community meeting. The key lies in two questions.

  1. To what extent is the community’s social infrastructure capable of supporting collective action?
  2. To what extent will the work of the NGO promote that capacity for collective action?

Note that these are not questions answered neatly in theoretical models designed in a vacuum prior to having community experience. These questions require time, understanding, and an appreciation for the complex ways in which “community” plays out. In my experience, they are deemed too complex and left unanswered or, worse yet, unasked. In the cases where I have seen things work I have seen one of two scenarios play out:

In the first, the NGO gets lucky. They find a community with a strong capacity for collective action, one that is already “moving,” and they get on board and support their efforts. Such cases are wonderful, but you have to wonder if these are the communities that really need a partner to work alongside them. No doubt the NGO helps, but what about the communities that aren’t “moving” in this way despite their best efforts?

In the second, the people involved “get it” without any specific training in regards to these issues. They sit, take time, discuss matters, and are willing to move slowly. Drs Raj and Mabelle Arole spent years on the ground in Jamkhed before starting serious health promotion activities beyond their clinic. I suspect that when they did start, they had a good sense of the answers to the two questions, and put themselves in the best position to succeed with the communities in the direst of situations.

Another more informal community meeting organized in a village nearby Jamkhed.

But why don’t we hear about a third case? One in which people sensitive to these issues and trained to understand them use efficient, empirical research techniques to learn the answers to these questions and use what they learn to be effective. Let me quote Dr. Aday again to give you the answer, “Good intentions are dangerous things.”

Clear as mud right? Let me elucidate.

There is a great extent to which the issues tackled by “poverty alleviation,” “development,” “empowerment,” and even “capacity building,” are social problems. True, there are economic concerns, health concerns, psychological concerns, political concerns, and public health concerns to name but a few. But what we tend to see today is these issues treated economically, medically, psychologically, politically, or epidemiologically without sufficient appreciation for the extent to which there are social factors contributing to them. Put any one of these approaches together with some sound social science, and I think you’ve got a winning approach.

And the truth is, this IS happening. Check out the literature on this stuff coming out of Australia, New Zealand, or even the UK. These kinds of approaches have been applied to reducing crime, improving small-scale economies, and of course improving health. The issue is that to those who don’t see the “social side” of these issues, these stories appear no different than their own.

I don’t write this to blame anyone. It’s merely a case of people being outside their field. A doctor isn’t qualified to give you advice on your investment portfolio nor is an economist qualified to diagnose your irregular heartbeat. Would you ask an epidemiologist to write a business plan? Why then would be expect these same individuals to diagnose the social component of a problem and recommend the most expedient course action?

Like I said, “Good intentions are dangerous things.” The willingness to help doesn’t always mean that you’ve put the best people in the best position to succeed. I think we all have to be humble here because so much is determined by things beyond what we know about or can control, but I think we owe it to everyone involved to make the savviest, most responsible decisions possible when trying to partner with the world’s marginalized.

So next time you’re left to wonder, “Why did this work?” or “Why didn’t this work?” or “Why did it work here and not there?” I challenge you to ask yourself, what sides of this issue were addressed? Which ones weren’t? See through the “development-ese” and fancy words, and look for community capacity buildling. The REAL thing.

The ability for a relatively stable group of people to act as a unit that makes full use of its diversity is special. It’s the power of community and I’m convinced that it’s going to change the world in the next 50 years.

The only question is, how do we get people to understand it for what it is instead of using it as a label on things that it isn’t? When we figure that out, I think we’ll be a huge step closer to getting development to work more than just sometimes.

…and other days you have to just sit around. This is one of the realities of being in India I guess.

Me passing the time. Probably on espn.com...


For the past three weeks, I’ve been a step away from starting the next phase of my research. I needed to do one seemingly simple thing: arrange for regular village visits. Perhaps I was a bit naive, but I imagined this process would play with me consulting the staff, picking days each week, and then going to the villages.

That was over 3 weeks ago. Instead, I’ve been given a bit of a run around. First, I consulted the Village Health Workers for the villages I had to go and they recommend a few days of the week to avoid. Then I sat down with the Field Staff at CRHP and ruled out a few more. Then I picked days, arranged for the vehicles, and planned in earnest.

1 hour before my first visit, someone from the field staff approached me. He asked me if I’d consulted with a certain senior member of the staff. I said no, and he said, well then the VHWs probably don’t know you’re coming. “Oh,” was my response. This came as a bit of a surprise. So, I took the advice of the staff member, cancelled the days visit, and started to reschedule.

Some variation of this story has taken place again and again. I talk to the person I’m supposed to talk to and arrange things, and then something comes up – a special visitor pulls the field staff away, a festival means it’s a bad day to go to the village, or the power is off so everyone’s away from the village – and I can’t go.

I was always told to expect things to be slow and challenging, but I wasn’t ready for this.

The good news is I’m well prepared for when I do go. The bad news? After almost of month of running around, meeting with various people, and planning visits only to be called off, I probably won’t be able to make a village visit until after I get back from going home for Christmas.

I had a conversation with a friend here who did the PeaceCorps. She told me, “You have to be patient.”

It was easy for me to find the irony of my instinctive response, “But I was patient for soooo long.” It’s fine. I’m in this for the long haul, so I’ll roll with the punches if I have to.

In the meantime, I’ll read papers, books, articles et al, and just try to enjoy the chance to be here and build relationships.

As Conor would say, “This is India.”


My Friend, Reshma

Note: This is an article I recently wrote and submitted to the United States India Education Foundation along with my normal monthly report. I hope that they’ll be able to find an appropriate venue for it to be shared or published. For now, I hope you enjoy this story from my experience in India thus far.


On the second floor of the Julia Hospital in Jamkhed, Maharashtra there’s a small room. Like most of the other rooms in the hospital, it has a window, a bed, and stool inside it. Also like most of the other rooms, it has a sterile sort of smell to it. The not-altogether-pleasant kind you’d associate with a hospital room that’s currently in use.

But it’s not like any other room in the hospital. Underneath the plain hospital furniture, there’s a small plethora of art supplies stashed away neatly. Every day, a young girl makes three trips from the room returning with tea and a meal. But most of all, unlike all the other rooms in the hospital, it’s the home of a friend of mine – a long-term burn patient named Reshma.

Reshma’s story is, at the onset at least, not an uncommon one. She was married at the age of 15, had three children in quick succession, and had regular disagreements with her husband regarding the family expenses. These escalated when her mother-in-law got involved. That much is clear.

What happened next isn’t. What we know for sure is that somehow Reshma was covered in kerosene and that someone lit her on fire. She may have done it herself in attempt to commit suicide or someone else may have done it to her. We’re simply not sure.

After her brother-in-law put out the flames, she was taken to the government hospital and, after some initial treatment, told go somewhere else. She had burns covering 50% of her body, and the doctors recommended that she go to Ahmednagar, nearly 2 hours away. Her aunt, however, worked at the Comprehensive Rural Health Project (CRHP) in Jamkhed – a place with international renown, a reputation for serving those in need, and an institutional dedication to advancing the status of women in India. After a brief discussion with CRHP’s now deceased founder, Dr. Raj Arole, the decision was made to bring her to the Julia Hospital.


That’s where we met. I had recently arrived to start a 9-month stint as a Fulbright-Nehru Student Researcher at CRHP, and she was 4 months, an operation, and a few weeks of therapy out from the day her body was burned. I’d been invited to visit her along with an undergraduate from Duke University named Lisa Deng and an Occupational Therapy student from New York named Valia Kaloust.

Lisa and Valia led me to one of the hospital wards where we met Reshma. She cut an interesting figure against the background of hospital beds: a short woman, perhaps less than 5 feet tall, wrapped extensively in white bandages yet wearing a colorful head scarf and a salwar kameez. Her expression was serious, intense even, and she spoke laboriously yet also like a Bollywood actress who was fond of overacting.

We all took turns singing (each vocal outpouring, regardless of its quality, was met a loud “Wow!” from Reshma) and talking about our day. Then, after 10 minutes, we left. Reshma seemed tired and ready for us to leave. Weeks later, as Lisa and Valia prepared to back to the US, they told that that she’d tried to commit suicide twice since I’d arrived in India. They asked me to visit her regularly and to try and keep her spirits up.


Reshma (sitting) and Valia during an occupational therapy session. Photo courtesy of Valia Kaloust.


So for the next month, I tried to do just that. I, along with another American student named Conor McWade, visited regularly. Conor and I helped Reshma practice her English, sat and colored with her, and talked with her about everything we could in our broken, nascent Marathi. I’d like to say that it wasn’t awkward, that she seemed happier each time, or that we found a lot to talk about. But truth is, it was awkward, she didn’t seem happier, and we struggled to know what to do and what to talk about. After a month, we wondered if we were helping at all.

Enter Kim Karnatz, a fellow Fulbrighter based in Delhi. We’d become friends during our Pre-Departure Orientation, and she decided to come visit CRHP after hearing me talk excitedly about it. We’d originally planned for her to help out with a project at CRHP’s pre-school, but when that didn’t work out, she ended up spending a significant part of her week in Jamkhed with Reshma.

I’m still not sure what they talked about, but somehow with Kim’s smattering of Hindi and Reshma’s command of basic English, they talked for hours each day in that small, sterile smelling room with the art supplies. And that’s when things started to change. After spending months in that room with virtually no exposure to the outside, Reshma told us that she wanted to go shopping with her new friend, “Kimmy.”


Reshma (second from the right) along with Karnatz (crouching) and a few other friends prepare to go shopping in Jamkhed. Photo couresty of Kim Karntz.


From that point on, Reshma’s story has become increasingly unconventional. Despite her husband leaving her, she’s recovering emotionally. She dreams about what she’ll do when she leaves the hospital.

In an interview with Meredith McLaughlin, an Intern at CRHP, she had previously expressed her desire to become a nurse. But nowadays, she’s actually starting to visit other patients in the hospital. She’s taken a much more active interest in her therapeutic activities (coloring, drawing, and other art-related tasks to help her regain her dexterity), and even coerced me into letting her paint my fingernails!

Kim’s visit only lasted a week, but things haven’t been the same since. My subsequent visits with Reshma have involved planning outings to visit her family, having skype sessions with all her afore-mentioned friends, and talking about how she can help other women in the future. For someone whose life today has been dictated so much by her past, it’s amazing to see her envision a new, exciting future.

Reshma has at least a few more months of recovery left before she can leave the hospital. She and I are currently planning to send Christmas gifts to her friends abroad, and I’m helping them scheme to send her presents as well. It’s amazing to me that we now live in a world where she can maintain these relationships, and that so much positive change was catalyzed by the gentle warmth and affection of a new friend. If you ask me, this is a big part of what being a cultural ambassador, and being a Fulbright-Nehru Student, is all about.


Reshma (gray scarf) and I talking with one of her friends in the United States using Skype while her niece, Kajal, looks on. Photo courtesy of Conor McWade.


From the CRHP website (http://Jamkhed.org):

The Comprehensive Rural Health Project, Jamkhed (CRHP) has been working among the rural poor and marginalized for over 40 years. Founded in 1970 by Drs. Raj and Mabelle Arole to bring healthcare to the poorest of the poor, CRHP has become an organization that empowers people to eliminate injustices through integrated efforts in health and development. CRHP works by mobilizing and building the capacity of communities to achieve access to comprehensive development and freedom from stigma, poverty and disease.

CRHP uses a three-tiered health system. At the village-level, you have Village Health Workers who provide basic primary care. They check on patients with chronic conditions, handle pregnancies, and refer people to the hospital when it’s necessary. The hospital is the highest rung of the care of the care ladder. Patients come here only when it’s necessary, and generally only after a referral from a VHW. As a result, patients avoids the fees of tertiary care centers unless they really need that level of care.

The intermediary level of care is the Mobile Health Clinic. It’s a team of doctors, nurses, and social workers that go to the local villages on a bi-weekly basis to provide medicines and care for basic diseases. Again, most of what you get here is primary care and the focus is on low-cost care. Patients are typically charged only a few rupees for care, but they can get referrals for more serious conditions – including if they need cataract surgery (a very common situation).


The mobile clinic set up inside a small buildling in the village of Sangvi.


In the US, we often talk about how if we could just invest more in preventative medicine that we’d be able to bring the costs of healthcare down. Well here at CRHP, it’s happening and it’s working. Individuals who live below the poverty line are able to afford the care they need. And in the rare instances they can’t, their villages have banded together to provide funds. It might sound incredible, but every village I’ve been to so far has had at least one remarkable story of village-level action taken to provide care for someone in need.


Asma, a CRHP nurse, explains to a patient how to properly use their prescribed medicines. In the foreground, an eye surgeon provides consults to cataract patients. Many of them will later come to the hospital for surgery.


Lately, I’ve been a fixture with the Mobile Clinic. I’ve worked alongside them for a few weeks in order to learn more about hypertension in the villages and carve out a niche working with the field staff. I’ve helped out when we’re swamped by taking blood pressures and helping to manage patients who are waiting. I speak enough Marathi now that I can be a little useful in this way. There’s also a doctor named David here from the US, and he’s been along for the ride as well. He tends to sit with the doctors of Aryuveda – Dr. Pathuk and Dr. Reddi – and they discuss patients together as they come. It’s beautiful to see the mixtures of techniques, approaches, and ultimately, choices.


David and Dr. Pathuk discuss a patient's condition.


My research in the coming months will focus on hypertension and what the local villages can do about it. The real goal is to develop the village’s capacity to act collectively, and that will have benefits in numerous ways… not just with hypertension. In all this, the data and records maintained by the Mobile Health Team will be crucial. They check up with patients who have known chronic diseases, update records by cross-checking them with VHWs, and bring that data back to CRHP. That data is the critical foundation for my work, and we’ll continue to use this clinic as a basis for explaining our presence in the villages. Essentially, we’ll explain that we’re looking into how to do more.


Just a random shot of an Aunty looking after a little girl during the clinic hours. Purely a human interest shot of one of the cutest little girls in the world.

I’m sad to say that I’m struggling with a real problem right now. I’m sure many of you have experienced it and can sympathize with my predicament. I’ve got the song “Friday,” as popularized by Rebecca Black, stuck in my head. So… in an attempt to exorcise this demon of a lyrically-shallow song, I think I’m gonna use it as a guide to my blog post. Here goes…

7 AM Waking up in the Morning/Gotta stay fresh, gotta get downstairs…

A typical view out the window of the MHT van as we cruise out of Jamkhed and towards a local village. Believe it or not, the photo credit here belongs to me.

Sleep has been, to put it mildly, an evolving issue for me. I started off barely sleeping for 3 hours a night during the first month I was in India, and then overcorrected and slept for 9 or 10 hours a night for a few weeks. Now things have really evened up. I start my day promptly at 7 AM, turn on the hot water heater, and am in the shower by 7:15 AM. I grab a quick breakfast at 7:45, go to morning prayers at 8. All this sets me up for my favorite part of the day: going out to a village with the Mobile Health Team (MHT).

The MHT is a group of medical staff and social workers, employed by the Comprehensive Rural Health Project (CRHP), to regularly visit villages. We (Oh yeah, I’m a part of it now) facilitate CRHP-backed programming, catch up with the Village Health Worker (VHW), and provide medical follow-up for patients. That’s pretty general, so let me get more specific.

These days, we’re helping to set up Women’s Empowerment Groups in the villages. We talk with the VHW about prospective members, regulations, and how that specific group should function. We then meet with interested women, discuss the challenges they might face in joining the group (husband/mother in law approval is the biggie), answer questions, and discuss what they want from the group. The groups will help these women get capital to set up their own small businesses, disseminate health information, and provide training (financial, medical, et al) as the group desires.

From a medical standpoint, we’re following up on eye surgeries, checking on patients with chronic conditions, and visiting patients the VHW needs/wants some back-up on. It’s a classic “stepped care” model where low-level concerns are handled for free, and village residents avoid the costs of going to a hospital unless their condition is truly serious.

All this work tends to involve an average of 3 cups of tea (I’m going sugar free now to avoid developing a case of diabetes), lots of joking around with each other and the village residents, and at least one explanation of how I’m from America, my parents are Indian, and that I’m learning Marathi. The head wagging action as I tell that story is consistently out of control.

Gotta get my bowl, gotta have cereal
I’ll be straight with you on this. The food situation at CRHP is not my favorite. Don’t get me wrong. The food is good. Breakfast is Pohe (flattened rice prepared with tumeric powder and served with nuts), toast, boiled eggs, tea or coffee, and a banana. Lunch is rice, daal (a lentil soup sort of preparation), chapatis (bread), and bhaji (a general term for a cooked vegetable). Dinner tends to be a repeat of lunch. The food is good… it’s just monotonous.
I mean, how many days can a man eat rice and daal in his life? The implicit answer, judging by the hard-nosed obstinance of our kitchen staff in sticking to this culinary course of action, is all of them. The only recompense comes when we have a large group of westerners in town. On such occasions, we’re given a taste of pancakes, french toast, macaroni and cheese, pizza, and other forms of forbidden fruit.
On the road, however, all this is a completely different story. See the picture below.

Exhibit A: Wada Pau

Wada Pau is about as Maharashtrian as you can get. During my travels over the past couple of weekends (Pune, Aurangabad, Mumbai, and now Delhi), I’ve eaten this almost exclusively while traveling on government buses. Let me explain. You’re sitting there, starting to get hungry. As the bus hits a stop, people crowd the entrance. Everyone attempts to get on and get off at the same time. Everyone except the Wada Pau wallahs. They wait and then step on the bus right before you leave. “Wada Pa! Wada Pa!” they chant. It’s so quick that it all sounds like a single word articulated at a single pitch. It’s a continuous droning with a strangely melodic quality. There’s something profoundly musical about the way they chant against the backdrop of an noisy bus station.

As you can see, this is a fried snack served with bread. The potato filling has tumeric and other spices so that it packs a bit of a punch. Grab a soda and two of these, and you’re set. It’s delicious and typically costs 10 or 15 rupees for 2. I’m crazy about them, obviously.

Seeing everything, the time is going’/tickin’ on and on, everybody’s rushin’

The time IS going. When I first arrived at CRHP, I thought I’d get into things quickly. I had also tried to prepared myself for the chance that things would shake out slowly. You can guess what happened.

I spent my first two months getting trained to be effective at doing research in Jamkhed. I took CRHP’s course of their approach and saw all their programs in action. I devoted myself to learning Marathi with the goal of being able to carry a conversation by October. And I started to build relationships with VHWs, the MHT, and the CRHP staff. It’s all paid off pretty well, and now I’m getting ready to embark on my research.

I’ll be working with two local villages in which to develop a collective action project that will improve the way that hypertension (or high blood pressure cases) are handled. We’ll start by selecting our villages based on the interest from that village, the interest of the VHW, the prevalence of hypertension in that village, and proximity to CRHP. Step two, we’ll get a good set of baseline data for at-risk patients. We’ll want to know how many cases there are, how bad they each are, how many people are at-risk, and what the underlying causes in THAT particular village are. Step three, share these results with the village. Step four, work together to develop a sustainable means of dealing with one of these.

Obviously, step four is the hard part. I’m scouring the research literature to learn what’s been done so that I have plenty of ideas to toss around. I’m sure they won’t quite fit, but they might not be a bad place to start thinking about what could work. I guess the real goal here is to tap into the village’s resources to do all this.

And now, I’ve got two solid months to get things going. And then I’ll be home for Christmas.

Popurt, a MHT member, sitting with a VHW as she runs a sugar level test using a urine sample and benedict's reagent.

Gotta get down to the bus stop/Gotta catch my bus, I see my friends

The people at CRHP have, without a doubt, been a real highlight. We just finished a stint in which we had three medical students around, and there’s a few new staff members hanging out with us now. Mostly, it’s Conor, me, and the younger doctors from the hospital. Now we’ve got a nurse and MPH named Sarah, and the promise of a group of Australians coming soon.

Our hangout time isn’t anything too special. But it’s wonderful. We eat our meals together, talk about days, play ping pong, watch American TV shows and Hindi movies, and just enjoy our lives together. The friendships are one of the few aspects of life at CRHP that really emphasizes a sameness between life in the US and in India. People are people and fun is fun in both cultures.

And of course, all the recent travel has been with this group. India, one of the afore-mentioned medical students, has shown a real propensity to try new foods and find them absolutely disgusting. As you might guess, it’s hard not to smile when that ritual unfolds.

The Medical students, a fellow Fulbrighter, and me at the Ellora Caves. Photo courtesy of Carolyn (far left).

Kickin’ in the front seat/Sittin’ in the back seat/Gotta make my mind up/Which seat can I take?

Ok, stay with me on this. Which seat you sit in in a CRHP vehicle is actually kind of a big deal. I mean, don’t get me wrong. It is, as you might normally think, a small thing. But if you’re a guest, then you’re always given the seat of honor (i.e. front seat). If you’re just one of the team, then where you sit is subtly dictated by a seniority system. I was gently invited up to the front for a long time… but now, I’m one of the team. I joke around with my friends Kuldeep and Surekha. I call the senior members of the team “Mama” (meaning Uncle) and “Bai” (meaning sister). I speak Marathi in the villages. And… I sit in the back with the rest of the junior guys.

It might sound a little weird to some, but for me, that’s a big win.

It’s Friday, Friday/Gotta get down on Friday/Everybody’s looking forward to the weekend, weekend

I won’t lie. I do get excited for the weekends. But mainly for just one reason: American Football. Thanks to my parents, I have NFL Gamepass and can watch any game I want in HD. It’s one of those small things that helps me feel in touch with home in some way. And hey, it’s a great season to be a New England Patriots fan. I simply can’t complain.

Partyin’, Partyin’, Yeah

Last line I’ll tackle, and it’s a doozy. Parties and alcohol are an interesting topic in rural India. Alcohol is, in general, considered not nice. Most women don’t drink at all, and the men who do aren’t looked upon terribly well. Only those who are progressive tend to enjoy the odd glass of wine or beer. For those of us who stay at CRHP, buying alcohol in town is a big “no no.”

So we give our money to the kitchen staff, and they purchase it for us. Due to the presence of speakers, AC, and a spare bed (i.e. frat couch) in my room, I have the odd party in my room from time to time (although one of the doctors was so embarrassed last time that he turned the picture of my family down so that my parents wouldn’t “see” him drinking). But the best parties are when we say goodbye to friends who are leaving. Then we have a big non-veg meal on the rooftop and a wide array of soft and hard drinks are laid out for everyone to enjoy.

It’s a funny thing, but one of the best memories with any visitor is always the goodbye party.

That’s all for now. Good to be back. And in a week, I’ll be back in action. Happy Diwali friends!

Just Another Day in Paradise

At least, that’s how it feels right now. I had a simply incredible morning yesterday.

It began at 7:30 AM when I woke up in an air-conditioned room after a full night’s rest without dreams. This was the first such night I’ve had in weeks. Until an AC gets installed in my own room, Dr. Shobha has made arrangements for me in another room that is air-conditioned. I still live in my own room, but I have a different room to sleep in. And for the moment, this system is working. I’m sleeping through the night, NOT dreaming, and feeling rested.

I got dressed and made my way to breakfast with Conor. As usual, Dr. Arjuna, Dr. Sachin, Dr. Reddy, and Dr. Tambekar, joined us. In minutes we were all laughing about I can’t remember what. We had “puri” (a light doughy pastry kind of like a mini-chapathi) with a yellow-ish preparation of potato. It was a little spicy, and I’m coming to want a little spice in my breakfast. A couple small cups of tea, and then we were back to our rooms to get some work done.

I focused on Marathi for a bit. Today I’m pushing to learn the past tense, and I’m aiming to know present, past, future, and present progressive by the end of the week. Dr. Sachin has volunteered to be my tutor for the next few weeks, and so it looks like a promising time for me to show everyone what I can do language-wise. Having the Doctors as friends really helps, they speak Marathi it to me all the time and are impressed when I know what they said.

Ok, here’s where the day got good. I went to the hospital for surgery. Upon arriving, I learned that the surgery had been pushed back a bit. This is pretty normal here. And Mr. Lazarus – the Hospital’s Administrator – remarked how Dr. Arole described time here. It’s IST (formally, Indian Standard Time), but Dr. Arole always described it as “Indian Stretchable Time.” I laughed heartily. Y’know, a good ‘ol guffaw. And it was all the invitation Mr. Lazarus needed to tell me more about the late Dr. Raj Arole.

He would be a block away, and the hospital would start buzzing because he was so electric. He had a serious expression on his face when he would enter, but once you spoke to him, he had a smile that filled his face automatically and you couldn’t help but feel comfortable around him. He went to the best medical school in India but if you sat with him, you’d feel he was on your level. He spoke so simply, and yet so deeply. He was a really incredible man.

Then, before I knew it, I was whisked off to surgery.

First up, we had a Ceasarian Section. Conor scrubbed in and Dr. Arjuna led. I watched. I was amazed. Normal deliveries aren’t my favorite. But C-Sections have a smooth elegance to them that I found to be aesthetically pleasing. I guess I’m pretty typical in that regard. I’m told that Doctors tend to prefer C-Sections. It just seemed like the baby was out in 5 minutes, the requested tubo-ligation was performed in another 15, and then the woman was closed up without much fuss.

I definitely had a “miracle of life” moment today too. The baby, a girl, struck me as beautiful. The nurse and surgery technician could tell I was impressed by the baby, and so they gave her to me to hold for a few minutes while they wrapped up some other stuff. I’m not normally one to get sentimental during a delivery, but today was different.

I looked into that little girl’s eyes and wondered what her life would be like. I prayed that she would grow up to experience love and to discover an India that would give her opportunities and choices. I’m working on article about my observations on the status of girls here, and all the stories I’ve written came flooding into my mine. Would any of these be hers? Would she write a new, happier story? Would she one day tell her story with tears in her eyes recalling when she wanted to kill herself or with a smile pregnant with her own memories of a happy life? Maybe both.

Like I said, I’m not one to get sentimental normally, but all that rushed through my mind in about 10 seconds. And then, I handed the baby back to Shama (the head nurse) and she gave her to the family. I waited. A smile would mean that they’re happy about the child, but a frown would mean were unhappy that she was a girl. Thank God, they smiled. That’s a good sign.

“Chan mulgi,” I said to the new child’s relative who held her while her mother was being closed up in the operating room. It means, “nice girl.” The relative smiled and nodded.

And again, before I knew it, it was time for the second surgery: an appendectomy . The patient, a middle aged woman, arrived and I scrubbed while she got prepped for anesthesia. I had put my own cap, mask, and glasses on this time. I felt comfortable, and smiled when I caught sight of myself in the mirror. I looked pretty good in all the get up today.

I scrubbed up, then walked into the OT (operational theater, as they say here) and was tied up into my sterile gown and handed my sterile packet of gloves. I put them on and watched as Popurt (the surgical technician) got the patient cleaned up. Dr Shobha had arrived and the anesthesia had been administered. I took careful note of Popurt’s work. One of these days I’ll be asked to do this to save others time. And so right now I need to take in as much as I can.

As Dr. Shobha came in, we made the final preparations. And just when she was finished getting ready, we were ready for her to make the incision. Again, my role consisted of holding clamps, skin, damp cloths, and occasionally cutting a freshly tied suture. But this time, I knew what was going on and I was proactive and useful. It was awesome to feel like more than dead weight.

The surgery went largely without incident. The woman’s intestines made some funny noises when we put them back in place after removing the appendix. As Dr. Shobha closed her up, she took time to teach me how to do final suturing. She wants me to learn so that she can have me close people up in the future. It’ll save her some time. So today I observed carefully. Soon she wants me to practice on an appropriate inanimate object, and then the day is coming when I’ll close up real patients.

Then, it was time for some more marathi before lunch. Afterwards I put some work in on my research proposal, and then had a brief class with Dr. Shobha. Seriously, no complaints. Just another day in Paradise.

Quick Quip from Surgery

Yesterday during surgery, I had a profoundly disturbing moment.

The patient had been given anesthesia from the waist down and his eyes were covered (as is typical here) during the procedure. However, when we were nearly 3/4 of the way through the surgery, I looked up towards his face (I was standing near his feet) and felt like I could see one of the patient’s eyes peering out from under the cloth. What I saw in that eye appeared to abject terror. What can you do in a moment like that?

I made a quick judgement and asked Conor to adjust the cloth so that the man couldn’t see what was going on. The surgeon was removing this man’s prostate, and frankly it’s not a pretty looking operation. I can only hope the man never felt a thing despite how scared he looked in that moment.

I thought, before coming here, that I might struggle with finding medical problems “cool” vs. caring for patients as individuals. So far I haven’t, and I’m not sure I will. Don’t get me wrong, I’m fascinated by the things I’m seeing medically, but it just doesn’t seem hard to keep that in context. At least, that’s what I’m saying now. I guess the real test will come a few years down the line.

But for now, I’m just glad that I have the opportunity to be around and just be human in the midst of a lot of opportunities to learn in the medical setting here.

The patient is in the foreground with the yellow cloth covering his face. One his relatives sits in the background and observes the procedure. Photo courtesy of Conor.


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