time in mumbai

i am back in amherst, after many hours of travel halfway around the world, but want to recap my last days in india.

i arrived in mumbai at 7 am on sunday morning, having slept only slightly on the sleeper bus from jamkhed. it was a bus without seats, but with bunk beds - wide enough for two - along either side of the aisle. they had little curtains covering them, and windows in each that i opened for the ride to get some air (AC sleeper doesn't mean the AC is on, apparently). abhi, a driver from CRHP, came with me, and we spent the night foot to head on the double bunk. not too comfortable. when i got to mumbai, the city was silent - no traffic, no masses, fewer smells. i got to the hotel and took a shower, turned on the AC and went to sleep until noon.

when i got up, i made a b-line for mahesh lunch home, where david, june and i ate the first time we were in mumbai. i got spicy house special prawns, which were even better than i remembered them. after a long lunch, i walked down mahatma gandhi (MG) road, and went shopping for some souvenirs. then i hopped in a taxi and went to mani bhavan, gandhi's house in mumbai that is now an historical society and museum (at right). it was free, which was an added bonus. then i took a taxi over to crossword bookstore, an indian barnes & noble's with a cafe and everything. i got a toasted cheese sandwich and a smoothie... pretty funny now that i think about it, but i was so excited to be eating non-indian food at that point. i bought a book on yoga and the alchemist, by paulo coelho (for the plane).

then i went back to the hotel and slept - - my game plan was to spend half of each day fully exploring the city, and half the day relaxing so as not to get overwhelmed.

monday morning, i woke and had breakfast at a little place across the way. i got idli sambar, which are (picture right) little cakes served with a spicy broth and coconut chutney. i had mango juice with it. oh god it was so good, thinking about it now... if you've had ethiopian food, the idli (cakes) taste like that large flat ethipian bread that you dip in stews. it is slightly fermented-tasting, but not bitter, and quite spongy. then i was off to colaba causeway by foot. i walked for a good hour downtown in the tourist district, where i bought hand-made chappals (little sandals with the toe-loop like those at left, but mine are red). then i bought indian sweets, which taste like a sweet cheese mixed with nuts, but it's formed into a cube with edible silver decorations on it. i stopped into coffee day, a chain around india which always promises air conditioning and purified water in cold foods (a concern at all times - only eat hot things! we are told as travelers, but this place made it possible, on a 90 degree day, to enjoy icy beverages and cool sandwiches). i got a mango milkshake that was dynamite. on my way back up colaba causeway, i bought a $6 suitcase to carry home all the things i had bought in india. as i hopped in a taxi, i hoped secretly that it would make it home (to give you an idea, the straps inside that clip together to hold your clothes in place were made out of fruit of the loom underwear elastic!)

i went home and napped, then ventured out to find some snacks and mango juice for the room. i wandered around some outdoor markets near my hotel, where there were no tourists at all, and enjoyed the city as the sun set. then i went back to mahesh lunch home - i couldn't get enough! - and had another delicious meal of chicken tikka and garlic naan, and ice cream made of some ingredient i'd never had that was really delicious. it had little nuts and gummied-fruit in it and was orange.

on tuesday, i woke up early and walked down to the prince of wales museum, the major museum in mumbai that houses all the indian sculpture, miniatures, tibetan and nepali art, as well as a natural history museum. you get a free audio tour with admission, so i spent a good two hours wandering around the museum, which - at left - is housed in a gorgeous indo-saracenic style building from the empire days. then i went to a great restaurant called delhi darbar, where i ordered north indian naan and butter chicken, then had custard apple-flavored ice cream. i had heard of custard apple all throughout my stay, as they grow it on the farm in jamkhed, and one of the main things i had heard was that it was a favorite ice cream flavor in india. it looks like an unripe cauliflower ball, and inside are little nubs, each containing an inedible black seed. but it's a very creamy fruit that tastes like a combination of milk and pear. it's really good.

then i was going to take a tour of bombay, but none were running, so i decided to take the ferry to elephanta island, a site in the middle of the harbor an hour from the shore that has some hindu caves. but when i got there, i was so happy to see... monkeys! they looked like this one (i searched "elephanta island monkeys" and this came up, so this monkey is actually from elephanta):

if it hadn't been for the monkeys, i would not have been glad i went to elephanta.

i came back, and took a taxi to swati snacks - a kind of swanky place where all the food is made with purified water, so i got bhel puri and pani puri - - generally served on chowpatty beach by vendors with carts, but safe to eat at this place. they are little spherical puffs that are popped at the top so that they can be filled with lentils, puffed rice, chutney and some spices. they explode in your mouth. i also had a kesar lassi, which was a sweet yogurt drink.

i headed back to the hotel to pack and prepare for the long trip home, and slept poorly because i watched a tv show documenting flight accidents and plane fires. not the brightest idea the night before 24 hours of air travel.

in the morning i woke to a call from dave, who was in the lobby (he was going on to delhi with june, and had come back to mumbai on the way). we had breakfast at the place across the street - masala dosa - and then i got into the taxi and headed to the airport.

the plane flight back was the longest of my life. as we landed i almost started crying because i was so happy to be home. then i saw zeke, who came to get me at the airport. and now i am home in amherst, picturing the imaginary line across the globe i took to get from jamkhed to amherst. i can't believe what a massive journey that is.

arrived in mumbai

i am here in mumbai after an overnight sleeper bus, which was surprisingly and luckily uneventful. i am off to a few museums today, through the heavy monsoon rains, and will depart wednesday to come HOME!

here are some updated photos of us from the july course:

http://www.jamkhed.org/Allied.shtml

two more days in jamkhed

i leave jamkhed in two days, on a night bus to mumbai, where i will spend three days in the city that shook me the first time i went there eight weeks ago. since the last time i wrote, i have spent three weeks working on a study of how alternative, herbal, and complementary medicine is used here at CRHP. it's been so interesting, and i can’t wait to continue working on it when i get back.

it will be hard to say goodbye to my friends here – rinske from holland, kate from australia, bernie from California (the new Mabelle Arole Fellow who will be here for the next ten months before starting medical school), and the community at CRHP. but i think i will come back in the future because this place is incredible. i've learned to be much more optimistic when approaching problems here; instead of anticipating obstacles, i should respond with solutions when, and if, i arrive at those obstacles. i've spent time on the farm, where they grow “diesel trees” – the oil from the leaves of this tree can be used directly as fuel – and moringa – a type of pod with seeds that are used to purify water so that water-borne illness has been cut way down in this area (it’s also used to purify the Nile in Sudan and Egypt), and the pod has more calcium than an equal weight of milk and more iron than most dark green vegetables, so a powder can be made from the pod and used to fortify the diet. they’ve brought access to water to the people of the drought-prone areas. and they’ve made jobs for people by teaching the trades that produce these potential means of livelihood. on the last day of the course, they gave us a quotation from Lao Tzu, the founder of Taoism:

Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say "We have done this ourselves.

this is exactly what CRHP does and it’s really refreshing.

dave and i (dave is my classmate from mt sinai who has been here all summer, did the course with me, and has been working on TB research the past few weeks) have had some great existential conversations the past few nights. they have been illuminating because they are in the context of development and health work. this summer i wanted to do a bit more soul-searching, since i’m searching for a spiritual side to life that suits me. many of the people at CRHP are christian, and thus have morning prayer and sunday services. i was raised catholic, so it’s not foreign to me, but at the same time there is a faith in god here as a means to give strength to the work they do. they say wonderful prayers like “god, give us the strength to continue our work, building communities, improving health, and empowering those who can’t now stand on their feet. we spread your love through the work that we do.” this is the reason for religion: to do good to and for others. and so i don’t get the sense in religious ceremony here that people, as at churches back home, are lost in ritual, mumbling a memorized prayer, thinking “god, help ME, bring ME this, make sure I achieve that;” instead, god is a symbol of love and goodness that one who does service brings to others. i think a community of others who believe people are good and that the purpose of life is to do good for others is all i need to develop that part of my life i feel is lacking. i have found some of that community here in jamkhed, and it’s very exciting to find kindred spirits, even if they are practicing religions (which i’m not sure i want do), who share some of my values.

in parting, though i'll post one more entry in mumbai, i will see you all soon! i arrive home on august 22!

two more days in jamkhed

i leave jamkhed in two days, on a night bus to mumbai, where i will spend three days in the city that shook me the first time i went there eight weeks ago. since the last time i wrote, i have spent three weeks working on a study of how alternative, herbal, and complementary medicine is used here at CRHP. it's been so interesting, and i can’t wait to continue working on it when i get back.

it will be hard to say goodbye to my friends here – rinske from holland, kate from australia, bernie from California (the new Mabelle Arole Fellow who will be here for the next ten months before starting medical school), and the community at CRHP. but i think i will come back in the future because this place is incredible. i've learned to be much more optimistic when approaching problems here; instead of anticipating obstacles, i should respond with solutions when, and if, i arrive at those obstacles. i've spent time on the farm, where they grow “diesel trees” – the oil from the leaves of this tree can be used directly as fuel – and moringa – a type of pod with seeds that are used to purify water so that water-borne illness has been cut way down in this area (it’s also used to purify the Nile in Sudan and Egypt), and the pod has more calcium than an equal weight of milk and more iron than most dark green vegetables, so a powder can be made from the pod and used to fortify the diet. they’ve brought access to water to the people of the drought-prone areas. and they’ve made jobs for people by teaching the trades that produce these potential means of livelihood.

on the last day of the course, they gave us a quotation from Lao Tzu, the founder of Taoism: Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say "We have done this ourselves".”

this is exactly what CRHP does and it’s really refreshing.

dave and i (dave is my classmate from mt sinai who has been here all summer, did the course with me, and has been working on TB research the past few weeks) have had some great existential conversations the past few nights. they have been illuminating because they are in the context of development and health work. this summer i wanted to do a bit more soul-searching, since i’m searching for a spiritual side to life that suits me. many of the people at CRHP are christian, and thus have morning prayer and sunday services. i was raised catholic, so it’s not foreign to me, but at the same time there is a faith in god here as a means to give strength to the work they do. they say wonderful prayers like “god, give us the strength to continue our work, building communities, improving health, and empowering those who can’t now stand on their feet. we spread your love through the work that we do.” this is the reason for religion: to do good to and for others. and so i don’t get the sense in religious ceremony here that people, as at churches back home, are lost in ritual, mumbling a memorized prayer, thinking “god, help ME, bring ME this, make sure I achieve that;” instead, god is a symbol of love and goodness that one who does service brings to others. i think a community of others who believe people are good and that the purpose of life is to do good for others is all i need to develop that part of my life i feel is lacking. i have found some of that community here in jamkhed, and it’s very exciting to find kindred spirits, even if they are practicing religions (which i’m not sure i want do), who share some of my values.

in parting, though i'll post one more entry in mumbai. see you all soon! i arrive home on august 22!

two more days in jamkhed

i leave jamkhed in two days, on a night bus to mumbai, where i will spend three days in the city that shook me the first time i went there eight weeks ago. since the last time i wrote, i have spent three weeks working on a study of how alternative, herbal, and complementary medicine is used here at CRHP. it's been so interesting, and i can’t wait to continue working on it when i get back.

it will be hard to say goodbye to my friends here – rinske from holland, kate from australia, bernie from California (the new Mabelle Arole Fellow who will be here for the next ten months before starting medical school), and the community at CRHP. but i think i will come back in the future because this place is incredible. i've learned to be much more optimistic when approaching problems here; instead of anticipating obstacles, i should respond with solutions when, and if, i arrive at those obstacles. i've spent time on the farm, where they grow “diesel trees” – the oil from the leaves of this tree can be used directly as fuel – and moringa – a type of pod with seeds that are used to purify water so that water-borne illness has been cut way down in this area (it’s also used to purify the Nile in Sudan and Egypt), and the pod has more calcium than an equal weight of milk and more iron than most dark green vegetables, so a powder can be made from the pod and used to fortify the diet. they’ve brought access to water to the people of the drought-prone areas. and they’ve made jobs for people by teaching the trades that produce these potential means of livelihood.

on the last day of the course, they gave us a quotation from Lao Tzu, the founder of Taoism:

Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say "We have done this ourselves".”

this is exactly what CRHP does and it’s really refreshing.

dave and i (dave is my classmate from mt sinai who has been here all summer, did the course with me, and has been working on TB research the past few weeks) have had some great existential conversations the past few nights. they have been illuminating because they are in the context of development and health work. this summer i wanted to do a bit more soul-searching, since i’m searching for a spiritual side to life that suits me. many of the people at CRHP are christian, and thus have morning prayer and sunday services. i was raised catholic, so it’s not foreign to me, but at the same time there is a faith in god here as a means to give strength to the work they do. they say wonderful prayers like “god, give us the strength to continue our work, building communities, improving health, and empowering those who can’t now stand on their feet. we spread your love through the work that we do.” this is the reason for religion: to do good to and for others. and so i don’t get the sense in religious ceremony here that people, as at churches back home, are lost in ritual, mumbling a memorized prayer, thinking “god, help ME, bring ME this, make sure I achieve that;” instead, god is a symbol of love and goodness that one who does service brings to others. i think a community of others who believe people are good and that the purpose of life is to do good for others is all i need to develop that part of my life i feel is lacking. i have found some of that community here in jamkhed, and it’s very exciting to find kindred spirits, even if they are practicing religions (which i’m not sure i want do), who share some of my values.

in parting, though i'll post one more entry in mumba. see you all soon! i arrive home on august 22!

finishing the course

we finished our one-month course yesterday, and received marigold, rose and jasmine garlands, so that "the fragrance of the flowers can spread like our service," and a scarf "for scholarship." we dressed in our saris and received certificates. then a group of thirty women from andra pradesh [who had accosted me more than a few times that morning, insisting that my sari was not put on properly (despite my very good attempt at putting it on myself after training sessions from, not one but, two women who work at CRHP) - i declined their help out of frustration and vowed to burn the damn thing because of the hours i've wasted trying to put it on] shook each of our hands and congratulated us, then took pictures with us for two hours in the screaming heat and the discomfort of my (admittedly poorly-put-on) sari.

today, saturday, we booked it to pune, rinske (a dutch medical student), kate (an australian social worker) and i. after a five hour journey in the maharashtra state bus - quite a trip, i must tell you, but adventure is not so glamorous, my friends - we arrived, only to be duped by a rickshaw driver. after we arrived at the bus station just outside pune, we walked up to a rickshaw driver and clearly stated that we wanted to go to the center of pune, a maximum five minute ride. ten minutes later we screamed at him over the traffic that we should not be getting on the mumbai highway, and, without turning off the meter, he said, as though shocked (though not convincingly), "pune center?" [despite the fact that he had repeated it confidently when we first asked him to take us there] and turned the vehicle around. When we arrived at our intended destination, he told us that the cost of the ride was 150 Rupees (the cost of the trip out of the city, back in, and to our destination). We told him we were giving him 50 Rupees, even more than the intended trip would have cost, and that was that. But he followed us to our hotel, smirking somewhat and not threatening, because we both knew that he was just trying to rip us off. Rinske started yelling at him, because she was even more frustrated than i, and when we told those at the hotel front desk what had happened, they told him to go away and he did.

afterwards, we realized that we had been fighting over two dollars, and felt stupid. ah well - it was the principle of the matter!

tonight we are at a high-speed internet cafe, which is a lovely treat after the very slow and inconsistent dial-up connection we have in Jamkhed (broadband has not yet reached that village). tomorrow we intend to go shopping and take it easy, then go back to jamkhed. monday morning i begin rotations in the hospital with dr. shobha.

i've been a bit homesick, partly because i've been nauseous the past few days and just crave my own bed in those moments of illness, but also because at this time of transition (the course ending and the rotation about to begin), it's easy to think of home and allow the desire for the comforts and familiarity of home to invade my thoughts. three more weeks, though - and i'm sure i'll be sad to leave because this experience has been just the renewer of spirit that i needed to confirm my choice of going to medical school, and created the images of patients that will motivate me through the next year of pathophysiology and pharmacology.

on that note, i'm off to experience some indo-chinese food and good company with kate and rinske. til next time...

In Memory of Muktabai Pol

Today was a sad day. A life had been lost before I even woke up, and it was several hours (until this afternoon) that I found that Muktabai Pol – a village health worker for over 25 years, who had improved the health landscape of her community and trained dozens of other health workers – had taken her own life.

We saw Muktabai in the hospital in our first days here, sitting on a bed, listless, a weak smile for us standing at the foot of her bed to say hello as we toured the hospital. We had read about her on the website and in the book on how The Comprehensive Rural Health Project (CRHP) at Jamkhed was started, and were all surprised to see her in the hospital. Dr. Shobha told us that she had issues with depression, and had been admitted periodically for her debilitating bouts of sadness. We saw her again in our second week, asleep, and in the third, when there was no glimmer of her legendary personality in her eyes, or even a forced smile for us and the new students with us. She managed to sit up, using her pillow to prop herself up off of her stomach where she had been lying, but she stared at the floor. She had gone home to her village at some point in the last week.

I say legendary personality because she was one of the first nine village health workers who, over the past 25 years, carried out the work of improving women’s status, decreasing child illness and mortality, assisting women in childbirth, and removing the stigma of leprosy and tuberculosis so that marginalized people in the community were once again accepted. All the village health workers accomplished these feats, but Muktabai must have been special, because when CRHP pooled a team to present at a World Health Organization event, they asked Muktabai to speak. This is what happened (from the book, Jamkhed: A Comprehensive Rural Health Project, by Drs. Raj and Mabelle Arole):

In a huge conference hall in Washington DC, over a thousand participants listen with rapt attention to Muktabai Pol, a village health worker from Jamkhed, India. The listeners include officials from WHO and UNICEF, ministers of health, health professionals and representatives of universities from many parts of the world. Muktabai shares her experience of providing primary health care in a remote Indian village. She concludes her speech by pointing to the glittering lights in the hall. “This is a beautiful hall, and the shining chandeliers are a treat to watch,” she says. “One has to travel thousands of miles to come to see their beauty. The doctors are like these chandeliers, beautiful and exquisite, but expensive and inaccessible.” She then pulls out two wick lamps from her purse. She lights one. “This lamp is inexpensive and simple, but unlike the chandeliers, it can transfer its light to another lamp.” She lights the other wick lamp with the first. Holding up both lamps in her outstretched hands, she says, “I am like this lamp, lighting the lamp of better health. Workers like me can light another and another and thus encircle the whole earth. This is Health for All.” The audience rises to its feet in a standing ovation.

This afternoon, I was unaware that anything was out of the ordinary, until I saw Shobha, the daughter of the founders of CRHP and Medical Director, leaving the hospital and saying, “we are having a ceremony. There has been a sad death of one of the VHWs” [Village Health Workers]. I asked who it was, and Alex, another student, replied, “Muktabai.” I immediately pictured her sad, tired eyes, but then envisioned this humble, illiterate woman in her clean but well-worn sari, lighting a candle in front of a hall full of doctors and public health officials. She was trained to do so much to impact the health of her community despite her simple background that she became a well-respected healthcare provider – a member of an elite and exclusive class – by a room full of “experts,” not to mention the hundreds in her village whose lives she saved or whose babies she welcomed safely into her hands and the world over all those years.

Members of the CRHP community gathered around as a van pulled up with a group of people from Muktabai’s village, including her husband, teary-eyed. They climbed out, then pulled a stretcher out with Muktabai on it, wrapped in a white shroud with her face and hair exposed, her eyes closed and her face relaxed and soft. They carried her lovingly into the garden of Dr. Arole’s house, where Shobha said a few words:

“Muktabai was a very special woman who loved the Lord. She had tried to commit suicide before, and last night she went home to her Father.”

All in attendance said a quick prayer with bowed heads, then lined up to place fistfuls of marigolds and rose petals on her resting body. I saw her husband then, lip quivering, eyes glassy, muttering, almost humming, in distress and pain. The women rubbed his arm and covered their hair with the ends of their saris. We lined up and, in a procession that wrapped around her, we each placed our offering of gold and red petals on Muktabai’s peaceful remains.

It is difficult to explain why I – a stranger to both the country and to Muktabai – can feel so moved by her passing and by the pain that those close to her are feeling. She, and all of these women, are so extraordinary in their contribution. But it is more the tragedy of her depression and the taking of her own life. When she did so much good, how could she have felt so sad? Today, though, she did seem at peace and encircled by those who love her, and by that I am comforted.

sites, a c-section and a sari

last week was fantastic. we explored child health and women’s status in class, then prepared to go to ellora and pune for the weekend.

on saturday morning, we left at 6 am to go to the ellora caves, which are spectacular hindu, jain, and buddhist temples and schools cut into a mountain. these are not spelunking caves, my friends. these are spectacular, cathedral-sized caves cut from the top down without scaffolding, thus they are cut from solid rock – not in pieces. the most amazing was a buddhist gathering hall with 50 foot high ceilings, all made of stone. our tour guide went behind the giant buddha stupa and starting chanting, and the sound reverberated throughout the entire temple. i could feel the vibrations.

after being hassled by vendors, i bought a beautiful garnet-colored beaded necklace for 100 rupees (2.50 USD). we piled into our jeep and went to the bus station to go to pune.

pune would be a major city if mumbai (bombay) weren’t four hours away. it has a population of 4 million people, universities, a banking center, malls and everything else that, coming from the rural areas, is shocking to see. of course there are beggars galore, and they are the most aggressive i have yet seen in india. they grab your arm if you ignore them, and i simply don’t tolerate that. even if you give them money, they continue asking for more, and many of them are professional beggars. it is clear that those who need alms most are those who are disabled or mothers with children, but those who are most in need aren’t as aggressive as those who beg professionally. i had to whip around once because a woman grabbed my arm tightly. another student with me in the course speaks hindi, and understood when a professional beggar woman said “i curse you” to her. we were able to buy some food to give to a woman and her children, and we did give to some of the poor and disabled, but it’s so difficult to think that 1) it doesn’t make much of a difference and 2) if you do give, twenty more beggars materialize.

we went to a german bakery and had masala chai and apple danishes. then we visited a broadband internet café, which was a relief after working on the spotty dial-up in jamkhed. rinske, the dutch medical student who i have befriended, and i split from the group to explore for the afternoon and had a fantastic time weaving through the streets and markets. the following morning, sunday, we went to have a half-hour ayurvedic massage. we stripped down to our underwear and got on the bed under a towel, thinking that they would fold the towel down to expose our backs. they pulled a curtain between our two beds, and each attendant took one of us. mine pulled the towel down as expected, but then pulled my underwear down in one quick motion and began kneading my buttocks!! i didn’t know what to do, so i just enjoyed the massage, which – soon after – moved up to my back and re-covered my pale and previously unhandled derriere. the massage was wonderful, though, and rinske and i jumped into an autorickshaw to hurry back to our hotel to check out.

the autorickshaws in india are basically motorcycles with a cover and a double seat behind the driver, so that you sit side-by-side with your fellow passenger. rinske and i sat there smiling as bollywood music blasted from the speakers installed behind our heads (the equivalent of the shelf-like area in a sedan under the back windshield). a ride across town costs less than a dollar.
that afternoon i presented my research proposal to the maharashtra association of anthropological sciences ethich committee. as at mount sinai, it didn’t get passed, but once the course finishes, i will work with dr. shobha in the outpatient department and in the hospital, and will document how alternative therapies are used in the hospital in a very informal way. it should be wonderful, and at least i had the enlightening experience of presenting to an indian ethics board!

today, i gave a presentation on taboo and superstition as barriers to healthcare. i focused on pregnancy, delivery, and childhood, and got to interview some village women about their experiences. one interesting belief is that women who die during childbirth do not go to heaven or hell, but become owls and watch over new babies and mothers in the hopes of cursing them because they were not able to have a child. in an effort to stay out of the sight of an owl, mothers and children stay in a hut built especially for childbirth for 12-40 days after delivery and all possessions of both mother and child do not see the light of day because the owl might take them and use pieces of their belongings in a spell to curse them. this view is no longer common due to the counseling of CRHP in these areas, and of course some degree of modernization; how isolated these villages are should not be underestimated, however. i am continuously surprised by how closed and cut off from society these communities can be.

we have been talking about water-borne illnesses and other communicable diseases over the past week, which has been really stimulating. last night i got to attend a c-section. the poor mother, 25 years old, had a high-risk pregnancy with high blood pressure and protein (albumin) in her urine, which indicates some kidney problems. after many hours of labor, the baby’s head was too big for her cervix, so they went into surgery. a beautiful baby boy came out after 3 minutes, then they closed her up and all was well. she had a seizure at 7:30 this morning – a complication of her previously high blood pressure, and was close to comatose when we checked in on her at 10:30 am. dr. shobha gave her a 50/50 chance of surviving. but we received word that she woke up and was breastfeeding this afternoon and looks as though she’s in the clear.

it's pretty incredible to be privy to these people’s lives in the hospital, and to see the successes of medical interventions. in the OR, i felt again the rush i have gotten before partaking – even passively, as i was last night – in the surgery. perhaps, despite thoughts of a public health career, i do belong in clinical medicine. the interactions with people here in the hospital have been overwhelmingly positive, and the simple things a doctor can do – things i understand after even one year of medical school – can change lives.

i have been thinking since i began medical school and opened the cadaver gifted to me and my classmates how little the average person knows about how our bodies work: what’s inside them, how they function, how they malfunction. here we have spoken much about education of village health workers, who in turn educate their fellow village people on simple remedies and diagnostics so that they can be in charge of their own health. i have been thinking about the lack of education about our health in schools and how only part of tenth grade biology actually covers biological systems. i think a national curriculum should be developed to teach about health in every school (along with my old idea and strong view that foreign language should be required in american schools starting in first grade).

this weekend, i will pick up the blousepiece that was made for me at the tailor’s; it is the belly-bearing shirt worn under a sari. the rest of the weekend i anticipate will be spent attempting to put a sari on, as it truly is an art. i'll let you know how it goes…

the everyday in india

i realized that i haven't really talked about what a daily schedule is like. i'll start with the food.

we eat at 8 am, 1 pm, and 7 pm, and most days the cuisine is the same for each, except breakfast has fewer vegetables and the occasional pancake from a western mix. we usually have the following:

dhal - lentils, which here are a yellow variety put into a bit of a watery stew with mustard seeds and eaten over rice
rice - white rice like that you get in chinese restaurants, but less sticky
chapati - basically a wheat tortilla that you tear and use as a potholder to eat the other food, especially the vegetables in sauce, but even the rice and dhal
squash - a type of "gourd," as they say, in a curry sauce
greens - sauteed or pureed, but never spicy
drumstick - a bizarre vegetable they serve in a curry sauce, which looks like celery but with a very fibrous husk around it. you cut it in half lengthwise and scrape the inside meat - which tastes like squash - off with your teeth and discard the fibrous strands of the outside
beans - green beans that are a bit less tender, usually in a spicy sauce

we've also been given hamburgers, beef stew, and chicken dishes - so much for the vegetarian stereotype. apparently, despite their holiness to hindus, cows (beef) are really cheap for meat. i guess the muslims rigged that deal!

here's a picture of us eating in our suite. you can see the chapatis in the foreground!

as for the rest of the daily activities, we usually have class from 10 to 1, break from 1 to 3:30, then have class again from 3:30 to 5:30 or 6. we have an hour to hang out or walk to a nearby lake, through some farms, and then we go to dr. shobha's house for dinner.

i have to mention that there are wonderful fruits here. papaya and banana are amazing, but what is out of this world is the mango. one ugly surprise was a beetle that had someone grown up inside the mango, but i swear there were no burrowing holes in the skin of the fruit. we even examined another one from the batch after that incident, and peeled it carefully to find another invader inside that one. i don't understand how it could have gotten inside unless it was in the fruit for the life of the fruit. please ponder and get back to me...

this weekend we are going to pune, the closest city, and to the ellora caves - hindu, buddhist and jain paintings inside these rock-cut caves. it should be fantastic.

i haven’t updated for a week because so much has been happening and because i got sick. first, i'll tell about the illness: i was not well until i stopped taking malarone – the anti-malarial that i was taking. now i feel great, and i will start taking chloroquine this weekend. that’s all there is to say about that without grossing you all out :)

now for the past week. oh, it’s been wonderful. last thursday, we went to ramayeshwar, a waterfall 15 minutes from CRHP that was supposedly formed when the god ram shot his arrow into the countryside. then he stayed there for fourteen years or so with his consort, sita. at the site where their table was is now a temple. we walked down 1000 or so stairs into the valley, over the pool under the waterfall and into the temple. it was magical.

the rain started to fall heavily as we climbed back up the stairs and eased as we looked out over the misty valley that looked almost rainforest-like, though it is drought-prone plateau in the middle of monsoon season in subtropical india! here’s rinske, david and june at the top on the look-out over the landscape.

last saturday, we went to the hospital to see patients with dr. shobha. sunday, as are all sundays here, was a day of rest, and that evening three students from SUNY downstate arrived – alex (who was the arole fellow last year), samar (pronounced summer; a bombayite who has lived all over the world and holds an MSc in computer science and a PhD in neuroscience), and ozzie (a quirky iranian-american with great stories and a reverence for che guevara’s commitment to his ideals). we began the course on monday.

we spent time talking about the social structure of india, including the caste system and the treatment of women; determinants of health; our expectations of the course; our values and beliefs; alma ata and primary health care; and more. but the wonder comes from the village visits. on our first morning, we piled into the CRHP bus and went to a village called patoda where sarubai, a village health worker, has been working for over 15 years. here she is with another village woman.

we were instructed to wander around in groups of two with a translator (i went with rinske, the dutch student, and pushba – our marathi teacher) and learn about the town. we walked through the homes of two families – one hindu, one muslim – who had businesses selling goats and grains, respectively. their homes were simple, made of brick and straw and mud, and their smiles were beautiful. in most homes live the mother, father, sons, daughters-in-law and the grandchildren. many other village children (and some adults) look on curiously, but smile when a smile is offered. the children continue to run up and say “hallo!” and shake our hands.
we left the homes of the families, and walked down a narrow road to a village well, where we met nani. she touched my face and said how fair i was and wanted a picture with me.

then she took us to her home and gave us tea and sang for us. while we were there, a woman came in who said she felt the spirit of lakshmi, a goddess, in her. she hooted and waved her arms around, joined at the wrists above her head, her whole body moving like a butter churner propelled by an invisible force. but she began laughing when she tried to do it in front of us, so i have to say respectfully that i’m not sure how possessed she actually was!

we discussed our village visit and many other topics over the ensuing days, heard more about village health workers’ lives, and got to know each other better, too. today we went to the cattle market in town, where villagers come from all over to sell cattle, goats and buffalo every saturday. then we went to the fruit and vegetable market and the hindu temple in town, where there were brightly colored sculptures of gods and goddesses that matched the electric hues and scents of the market surrounding them. There were mango, pomegranate and bitter squash vendors; men making fried sweets in steel pans filled with oil; straw baskets filled with fluorescent spices – orange, red, pink, green – under a blue tarp-covered stall; and snack mix stands attended by cross-legged women, sitting on top of the wagon on which all of their goods were stacked in unstable-looking pyramids. it was amazing.

today a preschool teacher and public health student from australia arrives, who will be here for the next month and will share my room. her name is kate. i’ll keep you posted on my new roommate and upcoming adventures.

on a parting note, a few things i’d like to share that are unique to India but have already become everyday to me:

- nodding yes consists of wobbling from side to side, not up and downone takes shoes off before

- entering a home, temple, or storeone eats with the right hand, as the left hand is used for washing

- limbupaani, or lemon water with salt and sugar, is a fantastic oral rehydration solution**
**[take from this last nugget what you will about what becomes a part of daily existence here!!]

with love,
zoe

the first few days

last night i slept well through the night; the past few days i had been sleeping from 9 pm to 3 am, waking and writing for two hours, then sleeping until 7 or 8. it was wonderfully calm in those mid-night hours, and i was alert and able to reflect during those times, though i'm still not sure i have realized i am here in india. it is very easy to feel stuck behind a viewing window when you are in a culture so different and seemingly inaccessible, but i'm hoping (and finding just a bit) that recapping what i've seen makes little cracks in the clear divider; hopefully it will shatter soon!

yesterday was an amazing day. we woke to a delicious breakfast and made our way to the hospital, where we met dr. shobha for morning rounds of the inpatients, stethoscopes in hand. we saw a patient with cellulitis that had spread to his scrotum that was becoming gangrenous. he was referred to a larger hospital because the infection had spread to his blood. we also saw some men who were recovering from prostate surgery, performed at CRHP by shobha; a child who had a parotid abscess (a salivary gland on the cheek near the ear); a boy who was recovering from paralyzing guillain-barre syndrome who, through rehabilitation, has gone from being paralyzed from the neck down to walking! we also saw a woman who had been treated for malaria, several women being monitored for bleeding during pregnancy, and - quite a story - a man who had a scrotum the size of a basketball. in surgery, it was found to be many loops of bowel - a huge, years-old hernia! they are all doing fine.

two nurses in white saris followed shobha, dave, amy, june and me around, writing hospital notes in english, which is surprising because enven in mumbai people speak very little english. i've had to get on with a demure smile and “namaste" (greetings) to everyone. following shobha around the hospital certainly adds to the smile return rate, but in the streets, there are looks – no, staring (i hope just curious). children in the village run up to us and, smiling and laughing, shake our hands and say “hallo” and “what is my name?” the latter means “what is your name,” we’ve learned, so we exchange names and off the children run. other groups of kids wave from a distance and when we wave back, they giggle into their hands. it's pretty amusing to us, too!
after we saw the inpatients at the hospital, we went to shobha’s office to see the outpatients. we saw a 15-year-old girl with an enlarged spleen and liver who we sent to get blood tests (they do most tests at their onsite laboratory); an HIV-positive woman with tuberculosis and an infected wound from a biopsied lymph node that had been enlarged; and a boy who had burn injuries on his hand that healed leaving his fingers unable to extend.

after another amazing meal for lunch, we went to a village wedding that was taking place behind shobha’s house (a site with a stage that is often used for weddings and other village celebrations). they carried in the groom, who was wearing a special turban, and then the bride – covered in a red shawl with gold ruffles on it, and wearing gold jewelry on her forehead and a chain from her earrings to her nose-ring. a hindu priest arrived on a motorcycle, as someone came around spooning into our cupped hands a mixture of rice and orange powder that we would later throw seven times throughout the ceremony toward the stage where the ceremony took place (we were all seated in chairs and cross-legged on the grass in the “audience”). the hindu priest sang a prayer, as did some village girls who might have been relatives of the couple, and the ceremony concluded with drumming. very auspiciously, it rained very hard for just a few minutes right after the ceremony ended, which was lucky for me too, because we all had to run onto the stage for shelter. that's where two village girls grabbed my hand and, introducing themselves and asking my name, dragged me to the bridge and groom to congratulate them.
that afternoon, we went into the village of jamkhed, on the edge of which we are located. i am glad i got another look, because the side streets of jamkhed on a sunny afternoon are very charming and very different from the main drag, muddied and dark in the monsoon rains on which we entered jamkhed on saturday. i bought some shampoo, laundry detergent, a notebook, two outfits, and face wash for about Rs. 800 ($20). they have bangle bracelet shops, bakeries, phone booths, schools, clothing stores (with both ready-made and material-for-fitting saris/salwar kameez), and numerous other convenience store type shops selling toiletries, snacks, jewelry, religious icons, and more. there were cows like the one pictured above everywhere.

tuesday, we awoke early to go to a village when CRHP-trained Village Health Workers (VHW) are working. the VHWs are low-caste females who have once-a-week training here in jamkhed to provide healthcare to their villages. they deliver babies, provide prenatal care, learn how to treat common diseases, counsel women, men and children on how to improve their health, and advocate for their community. the reliance on these women has dismantled the caste system in these villages to quite an extent over the 30 years they have been working, as high caste families must depend on them and have seen that the “untouchables” (the sub-caste group from which many of the VHWs are chosen) are thinking human beings who deserve to be treated equally. seeing that women can contribute so much has improved the status of women in these communities by showing the women how to advocate for themselves.

we arrived at the village with the Mobile Health Team from CRHP, which visits every village with which they have a relationship once per month, ready to provide HIV testing for pregnant women, along with counseling about the illness, which has much stigma here in india (which has the second highest rate of HIV/AIDS in the world, after south africa). we also got to watch a VHW do a prenatal exam using only her hands and a metal funnel-like instrument to hear the fetal heartbeat. she also looked at the tongues and inner eyelids of the women to see if they were anemic, and – if so – prescribed a certain kind of roasted bean with the size and taste of a chick pea for them to eat for the remainder of their pregnancy. we also learned about a lime juice-salt-sugar-water mixture that village women can make as an oral rehydration mixture for their children’s diarrheal illnesses. the number one killer of children under five in the developing world is diarrheal illness, which kills not because of a pathogen, but because the diarrhea dehydrates the children so quickly. the oral rehydration solution restores important electrolytes and water to the children, and improves survival. in the village we visited, only 3 children under five had died in the last fifteen years, and two of those were due to an accidental death and a birth defect that could not be fixed. these local efforts have improved health so much here – seeing all this has made advocacy and education seem like such accessible solutions to many of the world’s problems.

later, after returning to CRHP in jamkhed, we hopped into another CRHP bus to go to their farms where they sell some produce for a profit, but mainly provide refuge for ostracized patients with AIDS, leprosy, and mental illness, as well as teach farming techniques to local communities and individuals. they also have cows to produce milk for CRHP and some of the poorer communities they serve, and they raise chickens.

we sat with dr. arole – the founder of CRHP and father of shobha – in an area of young fruit trees, under a covering that filters out UV light and provides wonderful shade. we discussed the water-saving technologies used on the farm, much needed since this part of maharashtra state (the southern part of the ahmednagar district) is a drought-prone area, and there have been many monsoon seasons during which little rain fell, although mumbai – eight hours to the west – would be flooded.

this morning, a dutch medical student named rinske arrived, who will be here a little longer than us and will be taking the course with us. the four of us spent the morning with a group of korean students who are also here listening to the stories of several women working here at CRHP in jamkhed who have overcome abuse, both physical and social, from being in a low caste, for being women, for bearing girls instead of boys [a sidenote: feticide is common if an ultrasound determines that the fetus is female; it is therefore outlawed to tell families the sex of the child during prenatal ultrasounds, but this goes on illegally anyways.], and simply for being seen as the property of their husbands (their husbands are their gods). CRHP actively taught the women that they are thinking human beings . during this powerful session, i wondered whether we naturally believe that we are worthless or worth something. is there a natural inclination to feel one or the other, or are both taught?

the women who spoke to us were all beaten by their husbands and families, and had been married by age 14. now, they are property-holding entrepreneurs and contributing members of the CRHP community and their villages – no longer mistreated. they are advocates for themselves. one muslim woman was harassed by her community for opening a store when her husband died and for not wearing the veil and for being outside the home. she asked to have a meeting with the muslim leaders and said “if you give me money to live off of and feed my children, i will stay in my house, wear the veil, and stop working to earn a living.” the prospect of having to financially support her was too much for them, and they never bothered her again. the very fact that she could not be bullied brought her a lot of respect, and she does very well in her store today. she and the other women who told their stories have empowered many women in their communities by example.

this afternoon we had our first marathi class with pushba, a wonderful woman who did some of the HIV counseling in the project village the day before. she, like most here, has a wonderful smile and beautiful lines around her kind eyes to show she uses it often. we learned introductory phrases and pronunciation.

after watching wimbledon on tv last night in shobha’s house, we had a spaghetti dinner. what a western evening!

each day makes me quite grateful to be learning so much from these remarkable people – of CRHP and india. i do feel that i am in the presence of greatness here because of what i have seen and read in just a few days about the impact they have on the community.

at last... jamkhed

our smiling faces surrounded the table at dr. shobha’s house on saturday evening. the meal was delicious, but our joy stemmed from our relief at arriving in jamkhed after much travel, anticipation, and a finally dissipated baseline level of unease.

before we encountered folks from CRHP in pune, and outside of our hotel in mumbai (which had attendants posted outside and is gated), we were always on guard; constantly being the focus of attention makes it hard to feel either welcome or safe. furthermore, each leg of our journey required road travel (which is somewhat terrifying – more on that later) and meeting drivers - - the latter having a large possibility of not working out since we depended on the presence of english speakers and payphones to find the way to the next driver and vehicle. but things did work out, despite a few moments of dread at each stop before a friendly face emerged from the crowd. at least we are easy to spot!

the taxi from mumbai had to take us back to the airport to catch our shuttle to pune on saturday morning, which went smoothly. As we fussed with a payphone we didn’t know how to use, a friendly gentleman – who at first we ignored because he just seemed too friendly - - offered us the use of his cell phone. thank goodness, because it made it very easy to find our driver. then we felt badly – is it better to distrust and be proved wrong? we made our way to the shuttle, which i thought might be a van or large bus, but to my surprise and simultaneous consideration of the vast spectrum of wealth and poverty in india, we were led to an air-conditioned SUV, just for the three of us, which provided a very comfortable ride to pune.

the road to pune is called the mumbai-pune expressway, which is a modern highway (though i must say that i was surprised by the quality of all the roads we traveled on – even the rural ones – paved in cement, marked [though of course not heeded], with traffic signals in the cities). before we got to the expressway, we were stuck in gridlock for an hour in a mumbai suburb, moving along at a snail’s pace, being examined by passersby in autorickshaws, on scooters, and on foot. this suburb was exemplary of what we saw in many of the smaller villages, including jamkhed – mud and packed dirt on the sides of the road where store-fronts line the street. most shops look like storage units, some even with a sliding overhead garage door that, when open, exposes the entirety of the interior of the shop and the people – always more than one – sitting on stools or cross-legged on the floor inside, looking out. there is so much trash on the streets – from piles of trash to colored speckles kneaded into the mud, piles of wood splinters, old bicycle wheels, many of them the object of trade in stores, but - i feel sorry to say – i cannot discern what is trash from what is merchandise. there are also tarps and bits of plastic strapped everywhere as roofs and covers for doorways, which adds to a look of poverty and pollution. many of them are the blue tarps i associate with those handed out by aid groups to refugees. there are so many people everywhere. most adults – even those who are very poor – generally wear flip-flops or sandals, but there are tons of children and babies who run around barefoot, holding their mothers’ hands or playing with other shoeless children. the poorest children wear either tops or bottoms. there are also – as expected – tons of shrines, which are fascinatingly always clean, without chipping paint or trash around them, exteriors draped in marigold chains. trucks – or “goods carriers,” as is painted across the fronts of their cabs – are ornately painted, often have a picture of a god on the front and have marigold chains or little green chili peppers strung onto ornaments on the fronts of their cabs. little children sell these at toll booths on the highways.

despite the poverty observed in these towns, the indian women look so put together and beautiful. maybe this is a product of their dress: they wear saris or salwar kameez, which include a stole draped over the shoulders. to me, the stole is an unnecessary garment in that if you were without it, you would be covered and still – by western standards – dressed. perhaps it is this flowing element of the outfit that makes it seem so luxurious to me – and, of course, they are all dressed in bright colors, have the hindu red marking between their eyebrows, and beautiful jewelry – anklets with bells, dangling earrings and nose rings, bangle bracelets up their arms. indian men and children, on the other hand, often wear western clothes, so poverty is sometimes more readily apparent, though some hindu men do wear all white and caps that look like 1950s soda fountain busboy hats.

we finally made it to pune, though the monsoon rains started again while we were driving. just after exiting the highway, but before entering downtown pune, we drove through a gated community that reminded me of hilton head or golf course homes on long island. SUVs, gates around home, huge mansions. another world right there. apparently pune is a rich town, developed in recent years by indians returning from the west. the downtown – where the train station is – is not lined by mud as were streets in even mumbai, but is well-designed with parking spaces and even some sidewalks.

we were dropped at the train station to meet drivers from CRHP, and after a quick call (we figured out how to work the payphone), we were met by the smiling face of hakim. oh, the relief. to belong to someone here. to be able to small-talk. he walked us over to the car, and it was another air-conditioned SUV with the welcome decal words “Comprehensive Rural Health Project” on the front window. We put our bags in the back and climbed in. hakim sure puts the pedal down, boy. off we went.

this leg of the trip was quite different from the first – rural maharashtra is very lush. once every 20 minutes, we would pass through a village like the suburb of mumbai, but in between we saw beautiful green farms, herds of goats, grazing cattle, even two camels. there are stones with white powder on them and shrines on every farm – religious folk are everywhere, which you can also tell by the red powder dots on the foreheads of the hindus. stray dogs are everywhere, too; i wrongly assumed they were a fixture in cities alone. they are even on the compound here in jamkhed (but they are clearly not actively rabid – i do stay clear, however). there are also little goats and bristly pigs that eat the trash. we pulled into a rest stop one hour from jamkhed called “The Smile Stop,” where i ordered a masala dosa – a kind of freshly made pancake with potato curry in it that is served with coconut chutney and a kind of spicy broth/gravy. then i had my first encounter with the hole in the floor bathroom. here, you are only supposed to eat with your right hand, as you left hand is used to wash off after using the bathroom – there is no tp but rather a faucet in each stall. i luckily have my “charmin to go” roll – I think mastery of the faucet skill will have to wait, at least until my charmin runs out, if not longer.

shortly after this break, we arrived in jamkhed, and drove the the main drag to the CRHP property on the edge of town. there are houses for staff, a garden, little covered pagodas for sitting. we were led up to our rooms in a cement building with cool stone floors that feel wonderful on bare feet. there aren’t any scorpions or snakes, but there are these very cute little geckos that crawl up the walls – they are about 4” long, with those amazing little bubble toes. i've only seen two in two days, so it’s not as if we are infested!

my room is painted yellow, with a ceiling fan, two twin beds (i'll have to share my room during the july course), a bookshelf built into the wall, a mirror, and a little table I use as a dressing table under the mirror. i strung up my mosquito net, but there are dense screens on the windows, so i've only used it for a few hours each night. (i have two bites, but got them walking outside – not in the apartment.) our bathroom has a western toilet and a shower with a hot water heater. we also have a sitting area and a fridge stocked with bottled water.

we went to dr. shobha’s house with amy, the arole fellow who has been here for ten months, and enjoyed a wonderful meal and introductions. then we got a little tour of the grounds. when we came back, it was only 8 pm, but we were so tired that we took showers and went to sleep.

sunday we relaxed, read, napped and ate more delicious meals cooked here by the staff. at every meal so far, there has been white rice, dhal (lentils in sauce), chapati (a delicious whole wheat tortilla, made fresh), and a dish made primarily of dill, with garlic, tomatoes, and some little beans or grains in it. i've never had dill in such quantities; i've only had it as a condiment on fish before now, but this dish – forkfuls of the stuff – is delicious.

monday we will round at the hospital and go into town for errands. this week will be very laid back, as our course does not begin until july 2. it is quite a luxury to have time to write and read, though naps thus far have creeped into the schedule more than i would have liked. it's been two days, but i am starting – just – to feel settled in. there are still many cultural barriers to cross that i can’t imagine crossing; it seems to me now that it is entirely conceivable that i could leave india without having made any progress on understanding the culture. but one step at a time…

mumbai

my overwhelming sentiment, having been in mumbai for two days now, is wonder at the notion that life here exists the way it does while we exist the way we do. this is not a statement on poverty, or on the neglect of the developing world by the developed; my point is that the "entire world of india" seems a discrete dimension from ours. there are so many people, so much dirt, so many sounds and smells - - all packed together. there is no buffer zone between the rich and poor areas - our 4-star hotelin the kemp's corner area of mumbai is next to a construction site where a small family lives, sitting shoeless at all hours of the day. people all over the city lie languidly on public benches, sleep on the sidewalk. there are stray dogs and cats everywhere, and of course the cows (though they seem to prefer the slower pace of side streets to the main roads).

there are lots of three-lane roads in mumbai, but - i kid you not - they might as well not exist. taxis that would certainly not standards elsewhere (in addition to not having seatbelts) straddle street markings and drivers honk at those who drive within the confines of the lanes. meanwhile, islands divide main roads, but pedestrians scurry across between the moving traffic of bicycles, taxis, and the wealthy's cars and scooters to hop up on the dividers, then weave to the other side.

the largest slum in asia is here in mumbai, but i don't see how it is a single slum; we drove through several areas of densely-packed hovels with corrugated tin roofs. the highway from the airport passed by these, and the most indelible image i saw was a little girl of no more than seven, wearing only underwear and her hair in pigtails, barefoot on the highway, holding the hand of a toddler who must have been her sibling as they scanned the traffic looking for an opening in the flow for them to cross.

after our taxi driver (who didn't speak english) drove us to the wrong area of town, we finally made it to our hotel - the shalimar hotel. a lovely woman named doris gave us a special deal and took care of us, sending us a complimentary fruit basket and some cookies, claiming "it is important to take care of the doctors of tomorrow."

after showers and a good rest, we took a taxi to a fabulous restaurant called chetana in colaba where we were served vegetarian thali - - a kind of all-you-can-eat variety platter. it was delicious and filling. we attempted to stroll for a bit, but the streets were deserted at that late hour, save for some sleeping people and street dogs, so we took a taxi back and went to sleep.

today we awoke early and - a few complimentary indian newspapers in hand - made our way downstairs to the breakfast included in our hotel bill. we drank mango juice, ate parsley potatoes, lentil and mushroom balls with tomato-based curry sauces, and dosas with curried onions inside. after sending off some emails at the business center (from where i am currently writing this), we went off to mahatma gandhi road to stare and be stared at (a white girl and two east asians definitely garner a lot of attention). we walked by the campus of bombay university, through clothing stalls and saw the "maidans" - field used for playing cricket. we also walked by the victoria terminus - a vestige of the colonial empire still in use in a bustling area of town. then we went to waht i can only describe as a very first-world store called fabindia where we bought a few items of clothing - two short kurtas (a short-sleeved long dress worn over pants called salwars - the outfit together is called salwar kameez), one salwar, and a stole (worn over the shalwar kameez outfit). then we were off to mahesh lunch home - a mangalorean seafood lunch restaurant that was packed when we got there and had to wait outside. while we were waiting, a cow came barrelling down the SIDEWALK as if she owned the place - - and she did; the mass of people parted, some patted her on the rump, and off she went. i don't think you can prepare for something like that - yes, i knew cows would be everywhere, but in the flesh their presence is absurd - especially when i picture them on the streets in new york city or how well they are taken care of when so many indians are not. once we made it inside to the restaurant, we had delicious house special spicy prawns and vegetables in gravy with garlic naan. utterly fantastic food - heaven. the best thing is that we haven't gotten sick yet (knock on wood).

as we wrapped up our late lunch, we realized that elephanta island - one of the sites we had planned to visit - was no longer open, so we went instead to the gateway of india and to gawk at the beautiful taj mahal palace hotel. by 5 pm, we were pooped from the heat, smells, humidity, dirt and long walk. we came back to our hotel and took a nap in preparation for our next adventure tomorrow: our voyage to pune, then onward to jamkhed.

i must say that i am eager to be in a small town; one day in mumbai is really quite a bit to process. as i sit here, reading over what i've written, i realize that there is so much left out - so much that i'm not sure i can describe. the streets are infused with whiffs of sweet juice being made on the sidewalks, body odor, waste, incense, flavored cigars, herbal body perfume some people seem to wear that smells like cucumber and a mix of herbs, and roasted nuts. there seems to be a haze in which all these hang, or else the scents are bounced up in the air and kept afloat on the sea of people that densely fill each walkway and taxi in the street. deteriorating cobblestones underfoot lead to packed dirt, then to freshly laid bricks and cement paths. winding wide boulevards have tributaries of unpaved roads but feed into grandiose rotaries with central fountains. the city is as close to a jungle as i can imagine. there is no feeling of being unsafe, just being very foreign and pulled along in the sluggish current.

i picture myself as a speck on the map in asia, and think of you all many times each day across the globe at your own various sepcks. take care.

the night before the night before

welcome to my blog. this will chronicle my summer in jamkhed, india. i leave for mumbai on june 20, will stay in mumbai for 2 days, then head on to pune, where i will meet members of the comprehensive rural health project who will drive us to the village of jamkhed in a rural part of the ahmednagar district. all of this will be about 8 hours away from mumbai. i should arrive there on saturday june 23 late at night. i will be updating this as i am able, between taking a course in community health and development for the month of july, and carrying out research on chronic pain management for the month of august. i will also hopefully have the chance to teach some kids in the village how to play ultimate frisbee as i am taking a few discs with me to give them! there are errands to run today before i leave, so off i go...

counting down

in around 12 hours, i'll be leaving for the airport to begin the 18 hour journey to mumbai. and we still don't have a hotel... yikes. it does say, however, on the first page of my guidebook: "india rewards those who go with the flow," so i am trying to tone it down and get ready to be at the mercy of the "flow." a friend told me recently that when one undergoes "bite training" [if working with disturbed youngsters who have violent tendencies], you don't pull away at the risk of having your skin ripped off; instead, you push towards the biter. hopefully india won't be like having my arm chewed on, but ... it's an analogy.

i think the contents of my suitcase are pretty incredible. i haven't yet taken a trip like this, so i really went above and beyond to cover all the bases.

- medical creme: antifungal, anti-itch, antibiotic
- bandaids
- laxative, anti-diarrheals ["it's not a matter of if, but when..."]
- bug juice, sunscreen
- purell
- clorox wipes
- hand wipes [we will be eating with our hands]
- aloe
- anti-malarial drugs
- antibiotics
- duct tape
- mosquito net
- string
- sneakers, sandals
- raincoat and umbrella [monsoon season!!]
- sunglasses and hat [apparently there are bursts of rain, then hell-hot sun...]
- trail mix and granola bars
- flashlight
- hindi book
- midnight's children by salman rushdie
- love in the time of cholera by gabriel garcia marquez
- guidebook
- journal
- notebook for research
- toothbrush, toothpaste, soap
- two skirts, two pairs of pants, a shirt or two and plans to buy shalwar kameezes there!
- flash drive [they have computers there so you can email me]
- 2 frisbees
- plug to (bottle my anxieties and) stick in the sink when i wash clothes
- playing cards
- disposable cameras
- stethoscope

and i managed to get it all into one suitcase and a backpack - with an extra suitcase jammed in there to bring stuff back!

i have traveled enough around europe that i feel very comfortable doing so; in anticipation of a trip to europe, i can really picture the types of things i will do and how i will do them (eg. subway to train, what to expect from a 1-star hotel, what's safe). my insecurities about india are that i can't even picture myself there because - despite this modern age - i don't really know what it will be like. it's an adventure into the unknown. i anticipate writing again once i get to jamkhed in a few days, after having experienced the chaos of mumbai. i don't know what i will have seen, but i can't wait to share it with you...